Anordrin compositions and methods for treating diseases

ABSTRACT

The present invention provides methods and compositions for treating cancer, reducing side effects, and reducing postmenopausal symptoms comprising anordrin or analog thereof (such as anordrin) alone or in combination with at least one other agent selected from the group consisting of tamoxifen, raloxifene or functional equivalent thereof, and an aromatase inhibitor.

TECHNICAL FIELD

The present invention relates to methods and compositions for thetreatment of cancer or other diseases comprising a combination ofanordrin or analog thereof (such as anordrin), alone or in combinationwith another agent.

BACKGROUND

Estrogen binds to its receptors to regulate RNA transcription, stimulatecell proliferation and modulate metabolic signaling in many tissuesduring mammalian reproduction and development. Three genes forestrogenic binding proteins have been identified, encoding estrogenreceptor (ER) α and β, and G-protein coupled estrogen receptor 1(GPER1). ER-α and β have similar structural and functional domains,containing activation function domain 1 (AF-1), a DNA binding domain(DBD), a dimerization domain and activation function domain 2 (AF-2),which is the ligand binding domain (LBD). They both belong to thenuclear super family of ligand-dependent transcription factors and havehighly conserved DBD and LBD regions (95%). They regulate RNAtranscription upon ligand binding, which results in ligand-receptorcomplexes that can dimerize and translocate into the nucleus, where theybind to estrogen response elements (EREs) found in the promoters ofestrogen-responsive genes. This type of modulation is typically referredto as the classical estrogen pathway. ER-α and β also regulate diversebiological functions through membrane-initiated estrogen signaling(MIES), associating with plasma membrane by interaction with theirligand binding domain. The detailed molecular mechanisms of signaling bymembrane-associated ERs are still unclear. The modulatory effects ofestrogen mediated by membrane-associated receptors on cellproliferation, matrix/migration, metabolism and glucose homeostasis havebeen reviewed (1, 2). Furthermore, studies on ER knockout mice indicatethat ER-α is the dominant functional estrogen receptor, as compared toER-β. Three transcription variants of ER-α, -66, -46 and -36, have beenfound. ER-α-36 lacks the AF-1 domain and contains a partial ligandbinding domain. It has been found localized to the cell membrane andcytosol. Since ER-α-36 is restricted to modulating MIES and was found tobe uniquely expressed in tamoxifen-resisted cancer cells, such asMDA-MB-231 and Hec1A, MIES modulated by membrane-associated ER isthought to be responsible for the resistance to anti-estrogen therapyfound by some researchers (3,4).

Orphan G-protein coupled receptor 30 (GPER1) was found to bind E2(17-beta estradiol, an estrogen) (5) and modulate cell proliferation,resulting in resistance to anti-estrogen therapy. However, itsphysiological function is still a matter of controversy among someinvestigators (3). GPER1 knockout mice have been shown to exhibitcardiovascular and metabolic defects, with no apparent effect onfertility (6). Thus GPER1 may be involved in the modulation ofestrogen-mediated metabolic signaling.

The decreased production of estrogen in postmenopausal women leads tosymptoms that may adversely affect their quality of life for decades.Hormone (estrogen) replacement therapy (HRT/ERT) has been utilized totreat these symptoms since the 1940s. Studies showing an increased riskof breast and uterine cancer, as well as thromboembolism morbidity,associated with HRT have lead to a recent decline in its usage, andpostmenopausal symptoms remain a problem for many older women. Selectiveestrogen receptor modulators (SERMs) have been utilized as treatments toregulate estrogen signaling since the 1990s. However, the lack of a morecomplete understanding of the molecular mechanisms involved andinterfering cross-talk between selective modulators with differentestrogen receptors have made it difficult to design treatment regimensthat avoid the development of drug resistance and serious side effectsduring clinical usage.

Tamoxifen was marketed as an antagonist of the estrogen classicalpathway to treat breast cancer patients, and was also reported as anagonist of ESR-α-36, potentially leading to anti-estrogen therapyresistance while stimulating the growth of endometrial epithelium cells,resulting in endometrium cancer (7, 8). Raloxifene was marketed as anupgraded version of tamoxifen, having fewer side effects and theadvantages of inhibiting cancer cell migration and preventingpostmenopausal symptoms, such as osteoporosis. However, raloxifene canstill cause serious side effects common to tamoxifen treatment, such asthromboembolism and non-alcohol steatohepatitis (NASH) (9, 10). Thedetailed mechanisms responsible for the side effects caused by eitherraloxifene or tamoxifen are still unclear. Ipriflavone is a derivativeof phytohormone, and its metabolite binds to the ER-α LBD with a loweraffinity than E2, exhibiting reduced estrogenic effects. The metabolitesof ipriflavone and isoflavone show comparable binding affinity andactivity with ER-β as E2, and they have been utilized in some countriesas a medicine to prevent osteoporosis. However, their effectiveness wasnot supported in at least one clinical trial (11). Moreover, potentialside effects as seen with traditional HRT are still a concern to someinvestigators (12).

2β,7α-diethyl-A-nor-5α-androstane-2α,17β-diol (anordiol) was firstreported as possessing anti-estrogenic activity by Pincus et al in the1960s (13, 14). Li, R. L. esterified anordiol using propionic acid tosynthesize 2α,17α-diethynyl-A-nor-5α-androstane-2β,17β-diol dipropionate(anordrin, ANO) in 1969. Anordrin was marketed as an antifertilitymedicine using the brand name AF-53 in China beginning in 1976. Estrogenis known to cause hormone-induced cancer, and anordrin, as an estrogenreceptor antagonist, was subsequently found to inhibit malignant cellgrowth (15, 16, 17). As a non-prescription medicine in China, Chinesephysicians used it as an anti-tumor agent for nearly a decade underlegally licensed conditions. However, confusing results were reportedfor many patients during clinical therapy. Its clinical usage as ananti-tumor agent was stopped in 1998 after the introduction of theclinical trial law in China, and all of the relevant clinical data werenever collected and studied.

The disclosures of all publications, patents, patent applications andpublished patent applications referred to herein are hereby incorporatedherein by reference in their entirety.

BRIEF SUMMARY OF THE INVENTION

The present application in one aspect provides a method of treating acancer in an individual comprising administering to the individual: a)an effective amount of an anordrin or analog thereof (such as anordrin);and optionally b) an effective amount of at least one other agentselected from the group consisting of tamoxifen, raloxifene orfunctional equivalent thereof, and an aromatase inhibitor. In someembodiments, there is provided a method of reducing side effect of atleast one other agent by anordrin or analog thereof (such as anordrin),comprising administering to the individual an effective amount ofanordrin or analog thereof (such as anordrin) in combination with theother agent, wherein the other agent is selected from the groupconsisting of tamoxifen, raloxifene or functional equivalent thereof,and an aromatase inhibitor. In some embodiments, the other agent istamoxifen. In some embodiments, the other agent is raloxifene orfunctional equivalent thereof (such as raloxifene, lasofoxifene orbazedoxifene). In some embodiments, the other agent is an aromataseinhibitor, such as anastrozole. In some embodiments, the side effects ofat least one other agent comprise elevated sugar uptake, decreasedcellular ATP concentrations, or both. In some embodiments, the sideeffects comprise insulin resistance.

In some embodiments according to any one of the embodiments above, thecancer is selected from the group consisting of breast cancer, lungcancer, pancreatic cancer, gastric cancer, colon cancer, liver cancer,and CLL. In some embodiments, the cancer is resistant to treatment withthe other agent when not administered in combination with anordrin oranalog thereof (such as anordrin).

In some embodiments according to any one of the embodiments above, theindividual is positive for membrane bound estrogen receptor. In someembodiments, the individual is positive for VEGFR or EGFR.

In another aspect, there is provided a method of reducing apostmenopausal symptom in an individual, comprising administering to theindividual: a) an effective amount of an anordrin or analog thereof(such as anordrin); and optionally b) an effective amount of at leastone other agent selected from the group consisting of raloxifene orfunctional equivalent thereof and an aromatase inhibitor. In someembodiments, the other agent is raloxifene or functional equivalentthereof (such as raloxifene, lasofoxifene, or bazedoxifene). In someembodiments, the other agent is an aromatase inhibitor, such asanastrozole. In some embodiments, the postmenopausal symptom is selectedfrom the group consisting of fat liver, insulin resistance, high sugaruptake and/or low cellular ATP concentrations, weight gain, high bloodtriglyceride, and osteoporosis and organ atrophy.

In some embodiments according to any one of the embodiments describedabove, the anordrin or analog thereof (such as anordrin) and the otheragent are administered sequentially. In some embodiments, the anordrinor analog thereof (such as anordrin) and the other agent areadministered simultaneously.

In some embodiments according to any one of the embodiments describedabove, the individual is human.

In yet another aspect, there is provided a pharmaceutical compositioncomprising anordrin or analog thereof (such as anordrin) and at leastone other agent selected from the group consisting of tamoxifen,raloxifene or functional equivalent thereof, and an aromatase inhibitor.In some embodiments, the other agent is tamoxifen. In some embodiments,the other agent is raloxifene or functional equivalent thereof(including for example raloxifene, lasofoxifene, or bazedoxifene). Insome embodiments, the other agent is an aromatase inhibitor, such asanastrozole.

In some embodiments, the pharmaceutical composition further comprises alipid (such as corn oil). In some embodiments, the pharmaceuticalcomposition further comprises protein (such as casein).

In some embodiments, the weight ratio of anordrin or analog thereof(such as anordrin) and the other agent in the composition is about 1:20to about 20:1 (including for example about 10:1 to about 1:10, or about1:10 to about 1:15).

The pharmaceutical composition can be present in a unit dosage form, forexample an oral unit dosage form, such as capsules, tablets, pills,caplets, gels, liquids (e.g., suspensions, solutions, emulsions),powders or other particulates, and so forth.

Also provided are methods of using the pharmaceutical compositiondescribed herein for treating cancer, reducing side effects, andreducing a postmenopausal symptom as described herein.

These and other aspects and advantages of the present invention willbecome apparent from the subsequent detailed description and theappended claims. It is to be understood that one, some, or all of theproperties of the various embodiments described herein may be combinedto form other embodiments of the present invention.

BRIEF DESCRIPTION OF FIGURES

FIG. 1: Anordrin or analog thereof (such as anordrin) does not bind tothe ligand binding domain (LBD) of ER (2 μg GST-fusion protein coupleonto beads) resulting in inability to modulate the estrogen classicalpathway. A: The percent of ³H-E2 bound to ER-α-LBD after competitionwith E2, tamoxifen (TAM) or ANO, normalized with ³H-E2 alone aftersubtracting blank; B: 10% SGS-PAGE stained with coomassie Blue R250showing the GST fusion proteins purified by glutathione beads; C: Gel1shows the expression of Bcl-2 in MCF-7 cells treated by TAM, ANO orblank using western blotting and probing with anti-Bcl-2 antibody; Gel2shows the amount of actin protein in each sample; Gel3 is a longerexposure of Gel1.

FIG. 2: Anordrin or analog thereof (such as anordrin) blocks ³H-E2binding to ER-α-36 expressed in HEK-293 cells and inhibits MDA-MB-231cell growth and migration through the distribution of integrin β1 ontoplasma membrane. FIG. 2A: The percent of ³H-E2 bound to ER-α-36expressed in HEK-293 and competed by ANO or TAM, normalized with blank;FIG. 2B: The expression of ER-α-36 in HEK-293 cells was detected bywestern blotting with anti-ER-α antibody; FIG. 2C: ANO significantlyinhibits MDA-MB-231 cell growth (red columns) dependent on its dosagecompared to tamoxifen (TAM) (blue columns); FIG. 2D: ANO and EGFtogether inhibit MDA-MB-231 cell growth; FIG. 2E: 6 μM [ANO] inhibitsMDA-MB-231 cells migration tested by 8 μm transwell; FIG. 2F: 6 μM [ANO]plus 10 ng/ml [EGF] inhibits MDA-MB-231 cells migration tested by 8 μmtranswell; FIG. 2G: 6 μM [ANO] inhibits integrin β1 distribution ontoplasma membrane in MDA-MB-231 cells; FIG. 2H: 6 μM [ANO] inhibitsintegrin β1 distribution onto plasma membrane in MCF-7 cells.

FIG. 3: Anordrin or analog thereof (such as anordrin) promotes glucoseconsumption in MCF-7 cells and decreases blood glucose in mice. FIG. 3A:ANO enhances glucose consumption in MCF-7 cells compared to theinhibition by TAM; FIG. 3B: 250 nM [ANO] not only neutralized theinhibition of 1 μM [TAM] on glucose consumption in MCF-7 cells butenhanced above basal levels; FIG. 3C: ANO can significantly decreaseblood glucose concentration of female db/db mice.

FIG. 4: Anordrin or analog thereof (such as anordrin) prevents increasedbody mass and triglyceride accumulation in liver of ovariectomized (OVX)mice or normal mice treated with tamoxifen. FIG. 4A: ANO significantlyblocks increased body mass compared to ipriflavone (IP) in OVX mice;FIG. 4B: ANO significantly blocks TAM-induced body mass increase; FIG.4C and FIG. 4D: Paraffin sections of liver show that ANO cansignificantly decrease triglyceride accumulation compared to the samedose of IP in liver of OVX mice; FIG. 4E and FIG. 4F: Paraffin sectionsof liver show that ANO can significantly decrease the amount oftriglyceride and non-alcohol steatohepatitis (NASH) induced by tamoxifen(TAM) compared to the same amount of IF in liver of normal mice; FIG.4G: The grade of NASH is increased in liver cells closer to capillaryvessels.

FIG. 5. Anordrin or analog thereof (such as anordrin) decreases serum TGand viscosity induced by tamoxifen.

FIG. 6: Anordrin or analog thereof (such as anordrin) (7.5 μM) blocksEGF (10 ng/ml) induced cell growth in T47D cells.

FIG. 7: Anordrin or analog thereof (such as anordrin) inhibits HepG2cell growth and induces phosphorylation of ERK.

FIG. 8: Anordrin or analog thereof (such as anordrin) prevents atrophyof uterine and vagina in ovariectomized or tamoxifen treated mice.

FIG. 9: Anordrin or analog thereof (such as anordrin) causes hypertrophyof endometrial epithelial cells (increased cell size while retainingmonolayer), but does not induce endometrial epithelial cellproliferation in mice.

FIG. 10: Corn oil and casein formula (column oc) of anordrin or analogthereof (such as anordrin) enhances its activity to prevent atrophy ofmice uterus compared to methyl-cellulose (column mc).

FIG. 11: Anordrin or analog thereof (such as anordrin) preventsosteoporosis in ovariectomized mice.

FIG. 12: Anordrin or analog thereof (such as anordrin) inhibits ³H-E2binding to ER- and GPER1 fusion proteins expressed in HEK-293 cells.

FIG. 13: Effects of tamoxifen and anordrin or anordrin analog (such asanordrin) on cell growth, estrogen-controlled gene expression, and theirinteractions with the insulin pathway. A. IC₅₀ of anordrin or tamoxifenfor inhibiting growth of MCF-7 cells under culturing conditions with orwithout insulin in the media. Presence of insulin in the media reducessensitivity of MCF-7 cells to tamoxifen, but increases sensitivity ofMCF-7 cells to anordrin. B. RT-qPCR results showing log₂ fold changes ofexpression levels of genes under regulation by the estrogen classicpathway (such as BRCA1, ApoD, and COX7a), when MCF-7 cells were treatedwith anordrin (ANO), tamoxifen (TAM), or raloxifene (RAL), compared toMCF-7 cells without drug treatment. Anordrin treatment did notsignificantly affect BRCA1 transcription, but tamoxifen treatmentsignificantly inhibited transcription of BRCA1 and COX7a mRNAs. C.Western blot showing that removal of insulin from the culture medium ofMCF-7 cells resulted in increased expression of ER-α-36 at the proteinlevel, but no visible difference in the expression levels of GPER1 orER-α-66.

FIG. 14: Anordrin or analog thereof (such as anordrin) inhibits Hec1Aand Ishikawa cell growth.

FIG. 15: 6 μM ANO does not change the expression level of integrin β1 inboth MCF-7 and MDA-MB-231 cells MCF-7 cells were harvested and lysed inRIPA buffer. 40 μg total protein of cellular lysate was used for Westernblotting to determinate the expression level of integrin β1. Upper gelshows the expression level of integrin β1; Bottom gel shows the amountof actin.

FIG. 16: ANO does not change food uptake significantly in allexperimental groups under our testing conditions, A: ANO does notsignificantly change food uptake in db/db mice; B: ANO does notsignificantly change food uptake compared with other groups inovariectomized (OVX) mice; C: ANO does not significantly change fooduptake compared to tamoxifen (TAM) groups in normal mice.

FIG. 17: Total cholesterol in liver. A: Total cholesterol in liver ofovariectomized (OVX) group; B: Total cholesterol in liver of TAM/ANOgroup.

FIG. 18: Anordrin or analog thereof (such as anordrin) caused MCF-7culture medium to have decreased pH, turning yellow, MCF-7 cells wereseeded into a 24 well plate at density of 5×10⁵ cells per wellcontaining drug at indicated concentrations in 0.75 ml medium for 24hours. The pH of medium was measured using a pH meter.

FIG. 19: Hydrogene ion of anordrin is a dominant site responsible forinhibiting cell proliferation. Ethyne is substituted by alkyl or alkenylamine from C2-18 to synthesize derivatives of anordiol. MDA-MB-231 cellsare used to measure the drug activity. FIG. 19A: Concentration-dependentmorphological change and death of MDA-MB-231 cells; FIG. 19B: The activedrugs and concentration ranges.

FIG. 20: 3H-E2 does not bind to soluble ER- -36.

FIG. 21: Immunofluorescence staining (left panels) of paraffin sectionsof mouse livers using fluorescently labeled (red) antibodies againstER-a (top), GPER1 (middle) and ER-b (bottom). Nuclei were stained usingDAPI (blue). Images in the right panels are corresponding bright-fieldimages. Only GPER1 showed perinuclear localization.

FIG. 22: A. Transient knockdown of ER-α-36 using specific siRNAdecreased migration of MDA-MB-231 cells, but transient knockdown ofGPER1 (using specific siRNA) or control using scrambled siRNA resultedin no significant effect on migration of MDA-MB-231 cells. Cellmigration was measured used a matrixgel assay. B. Western blot showingthat specific siRNAs were effective at knocking down ER-α-36 and GPER1respectively at the protein level.

FIG. 23: Transient knockdown of ER-α-36 or GPER1 using specific siRNAsdecreased the sensitivity of MCF-7 cells to both tamoxifen and anordrin(or anordrin analogs) in terms of effects of the drugs on glucose uptakeand cellular ATP levels. A. Glucose uptake by MCF-7-cells treated withtamoxifen and/or anordrin (ANO) were measured using a fluorescentglucose analog 2-NBDG(2-deoxy-2-[(7-nitro-2,3-benzoxadiazol-4-yl)amino]-D-glucose). Knockdownof ER-α-36 or GPER1 by specific siRNAs resulted in a significantdecrease in glucose uptake in tamoxifen (TAM) or anordrin (ANO)-treatedMCF-7 cells, as compared to drug-treated MCF-7 cells without RNAiknockdown of ER-α-36 or GPER1. B. ATP concentrations in MCF-7 cellstreated with tamoxifen and/or anordrin (ANO) were measured using afluorescence-based ATP analysis kit. Knockdown of ER-α-36 or GPER1 byspecific siRNAs resulted in an increase in APT concentration intamoxifen-treated cells, but a decrease in anordrin-treated cells, ascompared with cells treated with corresponding drug but without RNAiknockdown. C. Western blot showing effective knockdown of ER-α-36 orGPER1 at the protein level by specific siRNAs.

DETAILED DESCRIPTION OF THE INVENTION

The present application provides methods and compositions forcombination therapy comprising anordrin or analog thereof (such asanordrin) in conjunction with a second agent for treatment of cancer,reducing side effects, and reducing postmenopausal symptom(s). Theinventions are based on the discovery of the unique properties andmechanism of actions of anordrin or analog thereof (such as anordrin).After a large scale screening, we surprisingly found that anordrin oranalog thereof (such as anordrin) is a specifically selective estrogenreceptor modulator of membrane-associated estrogen binding proteins. Onthe other hand, anordrin or analog thereof (such as anordrin) binds toGPER1 and functions as an agonist on the GPER1 pathway, which modulatesmetabolic signals to balance the consumption of bioenergy. Thebeneficial effects of anordrin or analog thereof (such as anordrin) thusinclude: i) the inhibition of malignant cell migration and growthregulated by membrane-associated estrogen receptors throughestrogen-mediated HER/VEGFR pathways, ii) the modulation of estrogenmetabolic effect as an agonist which leads to reduction ofpostmenopausal symptoms such as fat liver, weight gain, high bloodtriglyceride, and osteoporosis and organ atrophy, iii) theneutralization of detrimental effects by drugs such as tamoxifen,raloxifene and anastrozole, which include, for example, osteoporosis,non-alcohol steatohepatitis (NASH), atrophy of organs and endometriumcancer

Thus, the present invention in one aspect provides methods for treatingcancer comprising administering an anordrin or analog thereof (such asanordrin) alone or in combination with at least one other agent selectedfrom the group consisting of tamoxifen, raloxifene or functionalequivalent thereof, and an aromatase inhibitor.

In another aspect, there is provided a method of reducing side effect ofat least one other agent selected from the group consisting oftamoxifen, raloxifene or functional equivalent thereof, and an aromataseinhibitor, by administering anordrin or analog thereof (such asanordrin) in combination with such other agent.

In another aspect, there is provided a method of reducing apostmenopausal syndrome by administering an anordrin or analog thereof(such as anordrin) alone or in combination with at least one otheragent, wherein the other agent is raloxifene or functional equivalentthereof.

In another aspect, there is provided a method of reducing bloodviscosity and thromboembolism by administering an anordrin or analogthereof (such as anordrin) alone or in combination with at least oneother agent, wherein the other agent is raloxifene or functionalequivalent thereof.

Also provided are pharmaceutical compositions comprising anordrin oranalog thereof (such as anordrin) and at least one other agent selectedfrom the group consisting of tamoxifen, raloxifene or functionalequivalent thereof, and an aromatase inhibitor.

DEFINITIONS

It is to be understood by a person of ordinary skill in the art that thecombination therapy methods described herein requires that one agent orcomposition be administered in conjunction with another agent. “Inconjunction with” refers to administration of one treatment modality inaddition to another treatment modality, such as administration ofanordrin or analog thereof (such as anordrin) described herein inaddition to administration of the second agent to the same individual.As such, “in conjunction with” refers to administration of one treatmentmodality before, during or after delivery of the other treatmentmodality to the individual.

The methods described herein are generally useful for treatment ofdiseases. As used herein, “treatment” is an approach for obtainingbeneficial or desired clinical results. For example, for treatment ofcancer, beneficial or desired clinical results include, but are notlimited to, any one or more of: alleviation of one or more symptoms,diminishment of extent of disease, preventing or delaying spread (e.g.,metastasis, for example metastasis to the lung or to the lymph node) ofdisease, preventing or delaying recurrence of disease, delay or slowingof disease progression, amelioration of the disease state, and remission(whether partial or total). Also encompassed by “treatment” is areduction of pathological consequence of a proliferative disease. Themethods of the invention contemplate any one or more of these aspects oftreatment.

Individuals having “triple negative breast cancer” used herein refer toindividuals who are clinically negative for expression of estrogenreceptor (ER), progesterone receptors (PR) and HER2 protein.

“mER” refers to membrane-bound estrogen receptor. ER was facilitatedonto plasma membrane through the palmitoylation modification at aCysteine residue of its estrogen binding domain (LBD). ER-α-36 is atruncated ER-α variant. It remains palmitoylation motif (445-453) andpossesses a unique 27 amino acid instead of 140 amino acid region(456-595) of fullength ER-α at C-terminus. Since ER-α-36 possesses apartial LBD and predominantly localizes at plasma membrane and cytosol,it does not bind with estrogen resulting in losing the modulatingability of estrogen classical pathway.

“mER” “EGFR positive,” “VEGFR positive” used herein refer to individualswho are clinically positive for membrane-bound estrogen receptor,epidermal growth factor receptor (EGFR), or vascular epidermal growthfactor receptor (VEGFR).

The term “effective amount” used herein refers to an amount of acompound or composition sufficient to treat a specified disorder,condition or disease such as ameliorate, palliate, lessen, and/or delayone or more of its symptoms. In reference to cancers, an effectiveamount comprises an amount sufficient to cause a tumor to shrink and/orto decrease the growth rate of the tumor (such as to suppress tumorgrowth) or to prevent or delay other unwanted cell proliferation.

The term “individual” is a mammal, including humans. An individualincludes, but is not limited to, human, bovine, horse, feline, canine,rodent, or primate. In some embodiments, the individual is human.

The methods may be practiced in an adjuvant setting. “Adjuvant setting”refers to a clinical setting in which an individual has had a history ofa proliferative disease, particularly cancer, and generally (but notnecessarily) been responsive to therapy, which includes, but is notlimited to, surgery (such as surgical resection), radiotherapy, andchemotherapy. However, because of their history of the proliferativedisease (such as cancer), these individuals are considered at risk ofdevelopment of the disease. Treatment or administration in the “adjuvantsetting” refers to a subsequent mode of treatment. The degree of risk(i.e., when an individual in the adjuvant setting is considered as “highrisk” or “low risk”) depends upon several factors, most usually theextent of disease when first treated.

The methods provided herein may also be practiced in a “neoadjuvantsetting,” i.e., the method may be carried out before theprimary/definitive therapy. In some embodiments, the individual haspreviously been treated. In some embodiments, the individual has notpreviously been treated. In some embodiments, the treatment is a firstline therapy.

“Alkyl” is a linear or branched saturated hydrocarbon. For example, analkyl group can have 1 to 12 carbon atoms (i.e., (C₁-C₁₂alkyl)), or 1 to10 carbon atoms (i.e., (C₁-C₁₀alkyl)), or 1 to 8 carbon atoms (i.e.,(C₁-C₈alkyl)), or 1 to 6 carbon atoms (i.e., (C₁-C₆alkyl)), or 1 to 4carbon atoms (i.e., (C₁-C₄alkyl)). Examples of suitable alkyl groupsinclude, but are not limited to, methyl (Me, —CH₃), ethyl (Et, —CH₂CH₃),1-propyl (n-Pr, n-propyl, —CH₂CH₂CH₃), 2-propyl (i-Pr, i-propyl,—CH(CH₃)₂), 1-butyl (n-Bu, n-butyl, —CH₂CH₂CH₂CH₃), 2-methyl-1-propyl(i-Bu, i-butyl, —CH₂CH(CH₃)₂), 2-butyl (s-Bu, s-butyl, —CH(CH₃)CH₂CH₃),2-methyl-2-propyl (t-Bu, t-butyl, —C(CH₃)₃), 1-pentyl (n-pentyl,—CH₂CH₂CH₂CH₂CH₃), 2-pentyl (—CH(CH₃)CH₂CH₂CH₃), 3-pentyl(—CH(CH₂CH₃)₂), 2-methyl-2-butyl (—C(CH₃)₂CH₂CH₃), 3-methyl-2-butyl(—CH(CH₃)CH(CH₃)₂), 3-methyl-1-butyl (—CH₂CH₂CH(CH₃)₂), 2-methyl-1-butyl(—CH₂CH(CH₃)CH₂CH₃), 1-hexyl (—CH₂CH₂CH₂CH₂CH₂CH₃), 2-hexyl(—CH(CH₃)CH₂CH₂CH₂CH₃), 3-hexyl (—CH(CH₂CH₃)(CH₂CH₂CH₃)),2-methyl-2-pentyl (—C(CH₃)₂CH₂CH₂C₃), 3-methyl-2-pentyl(—CH(CH₃)CH(CH₃)CH(CH₃)CH₂CH₃), 4-methyl-2-pentyl (—CH(CH₃)CH₂CH(CH₃)₂),3-methyl-3-pentyl (—C(CH₃)(CH₂CH₃)₂), 2-methyl-3-pentyl(—CH(CH₂CH₃)CH(CH₃)₂), 2,3-dimethyl-2-butyl (—C(CH₃)₂CH(CH₃)₂),3,3-dimethyl-2-butyl (—CH(CH₃)C(CH₃)₃, and octyl (—(CH₂)₂CH₃).

“Alkenyl” is a linear or branched hydrocarbon with at least onecarbon-carbon double bond. For example, an alkenyl group can have 2 to12 carbon atoms (i.e., C₂-C₁₂alkenyl), or 2 to 10 carbon atoms (i.e.,C₂-C₁₀alkenyl), or 2 to 8 carbon atoms (i.e., C₂-C₈alkenyl), or 2 to 6carbon atoms (i.e., C₂-C₆alkenyl), or 2 to 4 carbon atoms (i.e.,C₂-C₄alkenyl). Examples of suitable alkenyl groups include, but are notlimited to, ethylene or vinyl (—CH═CH₂), allyl (—CH₂CH═CH₂) and5-hexenyl (—CH₂CH₂CH₂CH₂CH═CH₂).

It is understood that aspect and embodiments of the invention describedherein include “consisting” and/or “consisting essentially of” aspectsand embodiments.

Reference to “about” a value or parameter herein includes (anddescribes) variations that are directed to that value or parameter perse. For example, description referring to “about X” includes descriptionof “X”.

As used herein and in the appended claims, the singular forms “a,” “or,”and “the” include plural referents unless the context clearly dictatesotherwise. It is understood that aspects and variations of the inventiondescribed herein include “consisting” and/or “consisting essentially of”aspects and variations.

Methods for Cancer Treatment

The present invention in one aspect provides methods of treating cancerin an individual, comprising administering to the individual aneffective amount of anordrin or analog thereof (such as anordrin). Insome embodiments, there is provided a method of treating cancer in anindividual, comprising administering to the individual: a) an effectiveamount of anordrin or analog thereof (such as anordrin); and b) aneffective amount of at least one other agent selected from the groupconsisting of tamoxifen, raloxifene or functional equivalent thereof,and an aromatase inhibitor. In some embodiments, there is provided amethod of treating cancer in an individual, comprising administering tothe individual: a) an effective amount of anordrin or analog thereof(such as anordrin); and b) an effective amount of raloxifene. In someembodiments, there is provided a method of treating cancer in anindividual, comprising administering to the individual: a) an effectiveamount of anordrin or analog thereof (such as anordrin); and b) aneffective amount of tamoxifen. In some embodiments, there is provided amethod of treating cancer in an individual, comprising administering tothe individual: a) an effective amount of anordrin or analog thereof(such as anordrin); and b) an effective amount of lasofoxifene orbazedoxifene. In some embodiments, there is provided a method oftreating cancer in an individual, comprising administering to theindividual: a) an effective amount of anordrin or analog thereof (suchas anordrin); and b) an effective amount of anastrozole. In someembodiments, the anordrin or analog thereof (such as anordrin) and theother agent are both administered orally. In some embodiments, theanordrin or analog thereof (such as anordrin) and the other agent arepresent in a single composition (such as the pharmaceutical compositionsdescribed herein), for example in the form of an oral dosage form.

In some embodiments, the cancer is selected from the group consisting ofbreast cancer, lung cancer (such as small cell lung cancer and non-smallcell lung cancer), renal cancer, bladder cancer, pancreatic cancer,ovarian cancer, prostate cancer, brain cancer, colorectal cancer,leukemia, lymphoma, and multiple myeloma. In some embodiments, theindividual is mER positive. In some embodiments, the individual is EGFRpositive. In some embodiments, the individual is VEGFR positive. In someembodiments, the individual has solid tumor.

In some embodiments, there is provided a method of treating cancer in anindividual, comprising administering to the individual: a) an effectiveamount of anordrin or analog thereof (such as anordrin); and b) aneffective amount of at least one other agent, wherein the other agent isan EGFR inhibitor. In some embodiments, there is provided a method oftreating cancer in an individual, comprising administering to theindividual: a) an effective amount of anordrin or analog thereof (suchas anordrin); and b) an effective amount of at least one other agent,wherein the other agent is a VEGFR inhibitor. In some embodiments, thereis provided a method of treating cancer in an individual, comprisingadministering to the individual: a) an effective amount of anordrin oranalog thereof (such as anordrin); and b) an effective amount of atleast two other agents, wherein the two other agent are an EGFRinhibitor and a VEGFR inhibitor. In some embodiments, the method furthercomprises administering to the individual another agent selected fromthe group consisting of tamoxifen, raloxifene or functional equivalentthereof, and an aromatase inhibitor. In some embodiments, the cancer isEGFR positive. In some embodiments, the cancer is VEGFR positive. Insome embodiments, the cancer is mER positive. In some embodiments, thecancer is EGFR positive and VEGFR positive. In some embodiments, thecancer is mER positive, EGFR positive, and VEGFR positive.

Suitable EGFR inhibitors include, for example, cetuximab, panitumumab,erlotinib, gefitinib, and vandetanib. Suitable VEGFR inhibitors include,for example, bevacizumab, pazopanib, regorafenib, and sorafenib.

In some embodiments, the anordrin or analog thereof (such as anordrin)and the other agent are administered sequentially. In some embodiments,the anordrin or analog thereof (such as anordrin) and the other agentare administered simultaneously.

In some embodiments, the anordrin or analog thereof (such as anordrin)and the other agent are administered concurrently. For example, in someembodiments, the administrations of the anordrin or analog thereof (suchas anordrin) and the other agent are initiated at about the same time(for example, within any one of 1, 2, 3, 4, 5, 6, or 7 days). In someembodiments, the administrations of the anordrin or analog thereof (suchas anordrin) and the other agent are terminated at about the same time(for example, within any one of 1, 2, 3, 4, 5, 6, or 7 days). In someembodiments, the administration of the other agent continues (forexample for about any one of 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or12 months) after the termination of the administration of the anordrinor analog thereof (such as anordrin). In some embodiments, theadministration of the other agent is initiated after (for example afterabout any one of 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 months)the initiation of the administration of the anordrin or analog thereof(such as anordrin). In some embodiments, the administrations of theanordrin or analog thereof (such as anordrin) and the other agent areinitiated and terminated at about the same time. In some embodiments,the administrations of the anordrin or analog thereof (such as anordrin)and the other agent are initiated at about the same time and theadministration of the other agent continues (for example for about anyone of 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 months) after thetermination of the administration of the anordrin or analog thereof(such as anordrin). In some embodiments, the administration of theanordrin or analog thereof (such as anordrin) and the other agent stopat about the same time and the administration of the other agent isinitiated after (for example after about any one of 0.5, 1, 2, 3, 4, 5,6, 7, 8, 9, 10, 11, or 12 months) the initiation of the administrationof the anordrin or analog thereof (such as anordrin). In someembodiments, the administration of the anordrin or analog thereof (suchas anordrin) and the other agent stop at about the same time and theadministration of the anordrin or analog thereof (such as anordrin) isinitiated after (for example after about any one of 0.5, 1, 2, 3, 4, 5,6, 7, 8, 9, 10, 11, or 12 months) the initiation of the administrationof the other agent.

The anordrin or analog thereof (such as anordrin) and other agentsdescribed herein can be the agents themselves, pharmaceuticallyacceptable salts thereof, and pharmaceutically acceptable estersthereof, as well as stereoisomer, enantiomers, racemic mixtures, and thelike. The other agent or agents as described can be administered as wellas a pharmaceutical composition containing the agent(s), wherein thepharmaceutical composition comprises a pharmaceutically acceptablecarrier vehicle, or the like.

The methods described herein require administration of the anordrinand/or analog thereof (such as anordrin) and the other agent ineffective amounts. In some embodiments, an effective amount is an amountsufficient to delay development. In some embodiments, an effectiveamount is an amount sufficient to prevent or delay recurrence. Aneffective amount can be administered in one or more administrations. Inthe case of cancer, the effective amount of the drug or composition may:(i) reduce the number of cancer cells; (ii) reduce tumor size; (iii)inhibit, retard, slow to some extent and preferably stop cancer cellinfiltration into peripheral organs; (iv) inhibit (i.e., slow to someextent and preferably stop) tumor metastasis; (v) inhibit tumor growth;(vi) prevent or delay occurrence and/or recurrence of tumor, and/or(vii) relieve to some extent one or more of the symptoms associated withthe cancer.

Thus, in some embodiments, there is provided a method of inhibiting cellproliferation (such as tumor growth) in an individual, comprisingadministering to the individual: a) an effective amount an anordrin oranalog thereof (such as anordrin), and optionally b) an effective amountof at least one other agent selected from the group consisting oftamoxifen, raloxifene or functional equivalent thereof, and an aromataseinhibitor. In some embodiments, the effective amounts of the anordrin oranalog thereof (such as anordrin) and the other agent synergisticallyinhibit cell proliferation (such as tumor cell growth). In someembodiments, at least about 10% (including for example at least aboutany of 20%, 30%, 40%, 60%, 70%, 80%, 90%, or 100%) cell proliferation isinhibited.

In some embodiments, there is provided a method of inhibiting tumormetastasis (such as metastasis of breast cancer, pulmonary metastasis ormetastasis to the lymph node) in an individual, comprising administeringto the individual: a) an effective amount an anordrin or analog thereof(such as anordrin), and optionally b) an effective amount of at leastone other agent selected from the group consisting of tamoxifen,raloxifene or functional equivalent thereof, and an aromatase inhibitor.In some embodiments, the effective amounts of the anordrin or analogthereof (such as anordrin) and the other agent synergistically inhibittumor metastasis. In some embodiments, at least about 10% (including forexample at least about any of 20%, 30%, 40%, 60%, 70%, 80%, 90%, or100%) metastasis is inhibited. In some embodiments, method of inhibitingmetastasis to lymph node is provided. In some embodiments, method ofinhibiting metastasis to the lung is provided.

In some embodiments, there is provided a method of reducing incidence orburden of preexisting tumor metastasis (such as pulmonary metastasis ormetastasis to the lymph node) in an individual, comprising administeringto the individual: a) an effective amount an anordrin or analog thereof(such as anordrin), and optionally b) an effective amount of at leastone other agent selected from the group consisting of tamoxifen,raloxifene or functional equivalent thereof, and an aromatase inhibitor.

In some embodiments, there is provided a method of reducing tumor sizein an individual, comprising administering to the individual: a) aneffective amount an anordrin or analog thereof (such as anordrin), andoptionally b) an effective amount of at least one other agent selectedfrom the group consisting of tamoxifen, raloxifene or functionalequivalent thereof, and an aromatase inhibitor. In some embodiments, thetumor size is reduced at least about 10% (including for example at leastabout any of 20%, 30%, 40%, 60%, 70%, 80%, 90%, or 100%).

In some embodiments, there is provided a method of prolonging time todisease progression of a cancer in an individual, comprisingadministering to the individual: a) an effective amount an anordrin oranalog thereof (such as anordrin), and optionally b) an effective amountof at least one other agent selected from the group consisting oftamoxifen, raloxifene or functional equivalent thereof, and an aromataseinhibitor. In some embodiments, the method prolongs the time to diseaseprogression by at least any of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12weeks.

In some embodiments, there is provided a method of prolonging survivalof an individual having a proliferative disease (such as cancer),comprising administering to the individual: a) an effective amount ananordrin or analog thereof (such as anordrin) and optionally b) aneffective amount of at least one other agent selected from the groupconsisting of tamoxifen, raloxifene or functional equivalent thereof,and an aromatase inhibitor in some embodiments, the method prolongs thesurvival of the individual by at least any of 1, 2, 3, 4, 5, 6, 7, 8, 9,10, 11, 12, 18, or 24 month.

In some embodiments, the method is used to treat a primary tumor. Insome embodiments, a method of treating metastatic cancer (that is,cancer that has metastasized from the primary tumor) is provided. Insome embodiments, the method is for the treatment of an advanced diseaseor a lesser extent of disease, such as low tumor burden. In someembodiments, there is provided a method of treating cancer at anadvanced stage. In some embodiments, the method is for the treatment ofan early stage breast cancer. The methods may be practiced in anadjuvant setting. The methods provided herein may also be practiced in aneoadjuvant setting, i.e., the method may be carried out before theprimary/definitive therapy. In some embodiments, the method furthercomprises conducting surgery on the individual following the completionof the treatment. For example, in some embodiments when the cancer isbreast cancer, breast conserving surgery or mastectomy can be carriedout within about 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 weeks aftercompletion of the neoadjuvant chemotherapy.

In some embodiments, the individual has previously been treated. In someembodiments, the individual has not previously been treated. In someembodiments, the treatment is a first line therapy. In some embodiments,the breast cancer has reoccurred after a remission.

In some embodiments, the cancer is breast cancer. These methods can beused, for example, to treat, stabilize, prevent, and/or delay any typeor stage of breast cancer, such as early stage breast cancer,non-metastatic breast cancer, advanced breast cancer, stage IV breastcancer, locally advanced breast cancer, metastatic breast cancer, breastcancer in remission, breast cancer in an adjuvant setting, or breastcancer in a neoadjuvant setting. In some embodiments, the method isuseful for preoperative systemic therapy (PST).

In some embodiments, there is provided a method of treating breastcancer (which may be HER2 positive or HER2 negative), including, forexample, advanced breast cancer, stage IV breast cancer, locallyadvanced breast cancer, and metastatic breast cancer. In someembodiments, the breast cancer is luminal type B breast cancer. In someembodiments, the breast cancer is basal cell breast cancer. In someembodiments, the individual is diagnosed with T2, T3, or T4 lesion, or astage N, M0 or T1c, N1-3 and M0. In some embodiments, the individual hasan ECOG performance status of 0-1. In some embodiments, the individualhas skin metastasis to the ipsilateral breast. In some embodiments, theindividual has undergone prior therapy (such as hormonal therapy). Insome embodiments, the individual has not undergone prior therapy (suchas hormonal therapy). In some embodiments, the individual is awaitingdefinitive surgery. In some embodiments, the breast cancer is resectedbreast cancer. In some embodiments, the breast cancer is unresectedbreast cancer, such as unresected stage II or III breast cancer.

In some embodiments, the method is for treating an individual having oneor more of these risk factors resulting in a higher probability ofdeveloping breast cancer than an individual without these riskfactor(s). These risk factors include, but are not limited to, age, sex,race, diet, history of previous disease, presence of precursor disease,genetic (i.e., hereditary) considerations, and environmental exposure.In some embodiments, the individual may be a human who is genetically orotherwise predisposed to developing breast cancer who has or has notbeen diagnosed with breast cancer. Individuals at risk for breast cancerinclude, e.g., those having relatives who have experienced this disease,and those whose risk is determined by analysis of genetic or biochemicalmarkers. For example, the individual may be a human who has a gene,genetic mutation, or polymorphism associated with breast cancer (e.g.,BRCA1, BRCA2, ATM, CHEK2, RAD51, AR, DIRAS3, ERBB2, and/or TP53) or hasone or more extra copies of a gene (e.g., one or more extra copies ofthe HER2 gene) associated with breast cancer. In some embodiments, thebreast cancer is HER2 negative. In some embodiments, the breast canceris ER negative. In some embodiments, the breast cancer is PR negative.In some embodiments, the breast cancer is EP negative and HER2 negative.In some embodiments, the breast cancer is PR negative and HER2 negative.In some embodiments, the breast cancer is ER negative and PR negative.In some embodiment, the breast cancer is ER negative, PR negative, andHER2 negative.

The methods described herein are also useful for treating other solidtumors (such as advanced solid tumors). In some embodiments, there isprovided a method of treating lung cancer, including, for example,non-small cell lung cancer (NSCLC, such as advanced NSCLC), small celllung cancer (SCLC, such as advanced SCLC), and advanced solid tumormalignancy in the lung. In some embodiments, there is provided a methodof treating any of ovarian cancer, head and neck cancer, gastricmalignancies, melanoma (including metastatic melanoma and malignantmelanoma), ovarian cancer, colorectal cancer, and pancreatic cancer.

In some embodiments, the method is useful for treating one or more ofthe following: cutaneous T cell lymphoma (CTCL), leukemia, follicularlymphoma, Hodgkin lymphoma, and acute myeloid leukemia.

In some embodiments, the disease is a cancer of any one of thefollowing: basal cell carcinoma, medulloblastoma, glioblastoma, multiplemyeloma, chronic myelogenous leukemia (CML), acute myelogenous leukemia,pancreatic cancer, lung cancer (small cell lung cancer and non-smallcell lung cancer), esophageal cancer, stomach cancer, billary cancer,prostate cancer, liver cancer, hepatocellular cancer, gastrointestinalcancer, gastric cancer, and ovarian and bladder cancer. In someembodiments, the cancer is selected from the group consisting ofpancreas ductal adenocarcinoma, colon adenocarcinoma, and ovarycystadenocarcinoma. In some embodiments, the cancer is pancreas ductaladenocarcinoma. In some embodiments, the cancer is a tumor that ispoorly perfused and/or poorly vascularized.

In some embodiments, the cancer is pancreatic cancer, including forexample pancreatic adenocarcinoma, pancreatic adenosquamous carcinoma,pancreatic squamous cell carcinoma, and pancreatic giant cell carcinoma.In some embodiments, the pancreatic cancer is exocrine pancreaticcancer. In some embodiments, the pancreatic cancer is endocrinepancreatic cancer (such as islet cell carcinoma). In some embodiments,the pancreatic cancer is advanced metastatic pancreatic cancer.

Other examples of cancers that may be treated by the methods of theinvention include, but are not limited to, adrenocortical carcinoma,agnogenic myeloid metaplasia, AIDS-related cancers (e.g., AIDS-relatedlymphoma), anal cancer, appendix cancer, astrocytoma (e.g., cerebellarand cerebral), basal cell carcinoma, bile duct cancer (e.g.,extrahepatic), bladder cancer, bone cancer, (osteosarcoma and malignantfibrous histiocytoma), brain tumor (e.g., glioma, brain stem glioma,cerebellar or cerebral astrocytoma (e.g., pilocytic astrocytoma, diffuseastrocytoma, anaplastic (malignant) astrocytoma), malignant glioma,ependymoma, oligodenglioma, meningioma, craniopharyngioma,haemangioblastomas, medulloblastoma, supratentorial primitiveneuroectodermal tumors, visual pathway and hypothalamic glioma, andglioblastoma), breast cancer, bronchial adenomas/carcinoids, carcinoidtumor (e.g., gastrointestinal carcinoid tumor), carcinoma of unknownprimary, central nervous system lymphoma, cervical cancer, colon cancer,colorectal cancer, chronic myeloproliferative disorders, endometrialcancer (e.g., uterine cancer), ependymoma, esophageal cancer, Ewing'sfamily of tumors, eye cancer (e.g., intraocular melanoma andretinoblastoma), gallbladder cancer, gastric (stomach) cancer,gastrointestinal carcinoid tumor, gastrointestinal stromal tumor (GIST),germ cell tumor, (e.g., extracranial, extragonadal, ovarian),gestational trophoblastic tumor, head and neck cancer, hepatocellular(liver) cancer (e.g., hepatic carcinoma and heptoma), hypopharyngealcancer, islet cell carcinoma (endocrine pancreas), laryngeal cancer,laryngeal cancer, leukemia, lip and oral cavity cancer, oral cancer,liver cancer, lung cancer (e.g., small cell lung cancer, non-small celllung cancer, adenocarcinoma of the lung, and squamous carcinoma of thelung), lymphoid neoplasm (e.g., lymphoma), medulloblastoma, ovariancancer, mesothelioma, metastatic squamous neck cancer, mouth cancer,multiple endocrine neoplasia syndrome, myelodysplastic syndromes,myelodysplastic/myeloproliferative diseases, nasal cavity and paranasalsinus cancer, nasopharyngeal cancer, neuroblastoma, neuroendocrinecancer, oropharyngeal cancer, ovarian cancer (e.g., ovarian epithelialcancer, ovarian germ cell tumor, ovarian low malignant potential tumor),pancreatic cancer, parathyroid cancer, penile cancer, cancer of theperitoneal, pharyngeal cancer, pheochromocytoma, pineoblastoma andsupratentorial primitive neuroectodermal tumors, pituitary tumor,pleuropulmonary blastoma, lymphoma, primary central nervous systemlymphoma (microglioma), pulmonary lymphangiomyomatosis, rectal cancer,renal cancer, renal pelvis and ureter cancer (transitional cell cancer),rhabdomyosarcoma, salivary gland cancer, skin cancer (e.g., non-melanoma(e.g., squamous cell carcinoma), melanoma, and Merkel cell carcinoma),small intestine cancer, squamous cell cancer, testicular cancer, throatcancer, thymoma and thymic carcinoma, thyroid cancer, tuberoussclerosis, urethral cancer, vaginal cancer, vulvar cancer, Wilms' tumor,and post-transplant lymphoproliferative disorder (PTLD), abnormalvascular proliferation associated with phakomatoses, edema (such as thatassociated with brain tumors), and Meigs' syndrome.

In some embodiments, the cancer is a solid tumor (such as advanced solidtumor). Solid tumor includes, but is not limited to, sarcomas andcarcinomas such as fibrosarcoma, myxosarcoma, liposarcoma,chondrosarcoma, osteogenic sarcoma, chordoma, angiosarcoma,endotheliosarcoma, lymphangiosarcoma, lymphangioendotheliosarcoma,Kaposi's sarcoma, soft tissue sarcoma, uterine sacronomasynovioma,mesothelioma, Ewing's tumor, leiomyosarcoma, rhabdomyosarcoma coloncarcinoma, pancreatic cancer, breast cancer, ovarian cancer, prostatecancer, squamous cell carcinoma, basal cell carcinoma, adenocarcinoma,sweat gland carcinoma, sebaceous gland carcinoma, papillary carcinoma,papillary adenocarcinomas, cystadenocarcinoma, medullary carcinoma,bronchogenic carcinoma, renal cell carcinoma (including for exampleadenocarcinoma, clear cell renal cell carcinoma, papillary renal cellcarcinoma, chromophobe renal cell carcinoma, collecting duct renal cellcarcinoma, granular renal cell carcinoma, mixed granular renal cellcarcinoma, renal angiomyolipomas, or spindle renal cell carcinoma),hepatoma, bile duct carcinoma, choriocarcinoma, seminoma, embryonalcarcinoma, Wilm's tumor, cervical cancer, testicular tumor, lungcarcinoma, small cell lung carcinoma, bladder carcinoma, epithelialcarcinoma, glioma, astrocytoma, medulloblastoma, craniopharyngioma,ependymoma, pinealoma, hemangioblastoma, acoustic neuroma,oligodendroglioma, menangioma, melanoma, neuroblastoma, andretinoblastoma. In some embodiments the lymphoid neoplasm (e.g.,lymphoma) is a B-cell neoplasm.

Examples of B-cell neoplasms include, but are not limited to, precursorB-cell neoplasms (e.g., precursor B-lymphoblastic leukemia/lymphoma) andperipheral B-cell neoplasms (e.g., B-cell chronic lymphocyticleukemia/prolymphocytic leukemia/small lymphocytic lymphoma (smalllymphocytic (SL) NHL), lymphoplasmacytoid lymphoma/immunocytoma, mantelcell lymphoma, follicle center lymphoma, follicular lymphoma (e.g.,cytologic grades: I (small cell), II (mixed small and large cell), III(large cell) and/or subtype: diffuse and predominantly small cell type),low grade/follicular non-Hodgkin's lymphoma (NHL), intermediategrade/follicular NHL, marginal zone B-cell lymphoma (e.g., extranodal(e.g., MALT-type +/−monocytoid B cells) and/or Nodal (e.g.,+/−monocytoid B cells)), splenic marginal zone lymphoma (e.g.,+/−villous lymphocytes), Hairy cell leukemia, plasmacytoma/plasma cellmyeloma (e.g., myeloma and multiple myeloma), diffuse large B-celllymphoma (e.g., primary mediastinal (thymic) B-cell lymphoma),intermediate grade diffuse NHL, Burkitt's lymphoma, High-grade B-celllymphoma, Burkitt-like, high grade immunoblastic NHL, high gradelymphoblastic NHL, high grade small non-cleaved cell NHL, bulky diseaseNHL, AIDS-related lymphoma, and Waldenstrom's macroglobulinemia).

In some embodiments the lymphoid neoplasm (e.g., lymphoma) is a T-celland/or putative NK-cell neoplasm. Examples of T-cell and/or putativeNK-cell neoplasms include, but are not limited to, precursor T-cellneoplasm (precursor T-lymphoblastic lymphoma/leukemia) and peripheralT-cell and NK-cell neoplasms (e.g., T-cell chronic lymphocyticleukemia/prolymphocytic leukemia, and large granular lymphocyte leukemia(LGL) (e.g., T-cell type and/or NK-cell type), cutaneous T-cell lymphoma(e.g., mycosis fungoides/Sezary syndrome), primary T-cell lymphomasunspecified (e.g., cytological categories (e.g., medium-sized cell,mixed medium and large cell), large cell, lymphoepitheloid cell, subtypehepatosplenic γδ T-cell lymphoma, and subcutaneous panniculitic T-celllymphoma), angioimmunoblastic T-cell lymphoma (AILD), angiocentriclymphoma, intestinal T-cell lymphoma (e.g., +/−enteropathy associated),adult T-cell lymphoma/leukemia (ATL), anaplastic large cell lymphoma(ALCL) (e.g., CD30+, T- and null-cell types), anaplastic large-celllymphoma, and Hodgkin's like).

In some embodiments the lymphoid neoplasm (e.g., lymphoma) is Hodgkin'sdisease. For example, the Hodgkin's disease may be lymphocytepredominance, nodular sclerosis, mixed cellularity, lymphocytedepletion, and/or lymphocyte-rich.

In some embodiments, the cancer is leukemia. In some embodiments, theleukemia is chronic leukemia. Examples of chronic leukemia include, butare not limited to, chronic myelocytic I (granulocytic) leukemia,chronic myelogenous, and chronic lymphocytic leukemia (CLL). In someembodiments, the leukemia is acute leukemia. Examples of acute leukemiainclude, but are not limited to, acute lymphoblastic leukemia (ALL),acute myeloid leukemia, acute lymphocytic leukemia, and acute myelocyticleukemia (e.g., myeloblastic, promyelocytic, myelomonocytic, monocytic,and erythroleukemia).

In some embodiments, the cancer is liquid tumor or plasmacytomaPlasmacytoma includes, but is not limited to, myeloma. Myeloma includes,but is not limited to, an extramedullary plasmacytoma, a solitarymyeloma, and multiple myeloma. In some embodiments, the plasmacytoma ismultiple myeloma.

In some embodiments, the cancer is multiple myeloma. Examples ofmultiple myeloma include, but are not limited to, IgG multiple myeloma,IgA multiple myeloma, IgD multiple myeloma, IgE multiple myeloma, andnonsecretory multiple myeloma: In some embodiments, the multiple myelomais IgG multiple myeloma. In some embodiments, the multiple myeloma isIgA multiple myeloma. In some embodiments, the multiple myeloma is asmoldering or indolent multiple myeloma. In some embodiments, themultiple myeloma is progressive multiple myeloma. In some embodiments,multiple myeloma may be resistant to a drug, such as, but not limitedto, bortezomib, dexamethasone (Dex-), doxorubicin (Dox-), and melphalan(LR).

In some embodiments, there are provided methods of reducing side effectof at least one other agent by anordrin or analog thereof (such asanordrin), comprising administering to the individual an effectiveamount of anordrin or analog thereof (such as anordrin) in combinationwith the other agent, wherein the other agent is selected from the groupconsisting of tamoxifen, raloxifene or functional equivalent thereof,and an aromatase inhibitor. In some embodiments, the individual is mERpositive. In some embodiments, the individual is EGFR positive. In someembodiments, the individual is VEGFR positive.

Side effects of tamoxifen include, e.g., uterine cancer, non-alcoholsteatohepatitis (NASH), cardiovascular and heart attack, diarrhea,nausea, headache, hot flashes, sinusitis, weight gain, leg cramps, andankle swelling. Side effects of raloxifene include, e.g., decreasingblood triglyceride, NASH, cardiovascular and heart attack, blood clots,stoke, deep vein thrombosis, and pulmonary embolism. Side effects ofanastrozole include, e.g., diarrhea, nausea, headache, hot flashes,sinusitis, weight gain, muscle pain, organ atrophy, and osteoporosis.

In some embodiments, mER status is used as a basis for selectingindividuals for cancer treatment (or reducing side effects of the otheragents in cancer treatment). The levels of mER can be used, for example,for determining (and aiding assessment) in any one or more of thefollowing: a) probably or likely suitability of an individual toinitially receive treatment; b) probable or likely unsuitability of anindividual to initially receive treatment(s); c) responsiveness totreatment; d) probable or likely suitability of an individual tocontinue to receive treatment; e) probable or likely unsuitability of anindividual to receive treatment(s); f) adjusting dosages; g) predictinglikelihood of clinical benefits. The present application encompasses anyof these methods.

For example, in some embodiments, there is provided a method of treatingcancer in an individual (such as a human individual) comprisingadministering to the individual: a) an effective amount of anordrin oranalog thereof (such as anordrin); and optionally b) an effective amountof at least one other agent selected from the group consisting oftamoxifen, raloxifene or functional equivalent thereof, and an aromataseinhibitor, wherein the individual has a high level of mER. In someembodiments, there is provided a method of treating cancer in anindividual (such as a human individual) comprising administering to theindividual a) an effective amount of anordrin or analog thereof (such asanordrin); and optionally b) an effective amount of at least one otheragent selected from the group consisting of tamoxifen, raloxifene orfunctional equivalent thereof, and an aromatase inhibitor, wherein thelevel of mER is used as a basis for selecting the individual fortreatment. In some embodiments, the individual is selected for treatmentif the individual has a high level of mER. In some embodiments, thelevel of mER is determined by immunohistochemistry method. In someembodiments, the level of the mER is based on protein expression level.In some embodiments, the level of the mER is based on mRNA level. Insome embodiments, the level of the mER is based on Ca2+ signal inresponse to estrogen stimulation. In some embodiments, the methodfurther comprises determining the level of the mER prior to thetreatment. In some embodiments, the method further comprises selectingthe individual for treatment based on the mER level.

The levels of mER may be a high level or a low level as compared to acontrol sample. In some embodiments, the level of the mER in anindividual is compared to the level of the mER in a control sample. Insome embodiments the level of the mER in a subject is compared to thelevel of the mER in multiple control samples. In some embodiments,multiple control samples are used to generate a statistic that is usedto classify the level of the mER in an individual with cancer.

The classification or ranking of the mER level (i.e., high or low) maybe determined relative to a statistical distribution of control levels.In some embodiments, the classification or ranking is relative to acontrol sample obtained from the individual. In some embodiment thelevels of the mER is classified or ranked relative to a statisticaldistribution of control levels. In some embodiments, the level of themER is classified or ranked relative to the level from a control sampleobtained from the subject.

Control samples can be obtained using the same sources and methods asnon-control samples. In some embodiments, the control sample is obtainedfrom a different individual (for example an individual not having cancerand/or an individual sharing similar ethnic, age, and gender identity).In some embodiments when the sample is a tumor tissue sample, thecontrol sample may be a non-cancerous sample from the same individual.In some embodiments, multiple control samples (for example fromdifferent individuals) are used to determine a range of levels of mER ina particular tissue, organ, or cell population. In some embodiments, thecontrol sample is a cultured tissue or cell that has been determined tobe a proper control. In some embodiments, the control is a cell thatdoes not express the mER. In some embodiments, a clinically acceptednormal level in a standardized test is used as a control level fordetermining the mER level. In some embodiments, the reference level ofmER in the subject is classified as high, medium or low according to ascoring system, such as an immunohistochemistry-based scoring system.

In some embodiments, the mER level is determined by measuring the levelof a mER in an individual and comparing to a control or reference (e.g.,the median level for the given patient population or level of a secondindividual). For example, if the level of mER for the single individualis determined to be above the median level of the patient population,that individual is determined to have high expression of the mER.Alternatively, if the level of a mER for the single individual isdetermined to be below the median level of the patient population, thatindividual is determined to have low expression of the mER. In someembodiments, the individual is compared to a second individual and/or apatient population which is responsive to treatment. In someembodiments, the individual is compared to a second individual and/or apatient population which is not responsive to treatment. In any of theembodiments herein, the levels are determined by measuring the level ofmER. For example, if the level of an mRNA encoding mER for the singleindividual is determined to be above the median level of the patientpopulation, that individual is determined to have a high level of anmRNA encoding mER. Alternatively, if the level of mRNA encoding the mERfor the single individual is determined to be below the median level ofthe patient population, that individual is determined to have a lowlevel of an mRNA encoding mER.

In some embodiments, the reference level of mER is determined byobtaining a statistical distribution of mER levels.

In some embodiments, bioinformatics methods are used for thedetermination and classification of the levels of mER. Numerousalternative bioinformatics approaches have been developed to assess geneset expression profiles using gene expression profiling data. Methodsinclude but are not limited to those described in Segal, E. et al. Nat.Genet. 34:66-176 (2003); Segal, E. et al. Nat. Genet. 36:1090-1098(2004); Barry, W. T. et al. Bioinformatics 21:1943-1949 (2005); Tian, L.et al. Proc Nat'l Acad Sci USA 102:13544-13549 (2005); Novak B A andJain A N. Bioinformatics 22:233-41 (2006); Maglietta R et al.Bioinformatics 23:2063-72 (2007); Bussemaker H J, BMC Bioinformatics 8Suppl 6:S6 (2007).

In some embodiments, mRNA level is determined, and a low level is anmRNA level less than about 1.1, 1.2, 1.3, 1.5, 1.7, 2, 2.2, 2.5, 2.7, 3,5, 7, 10, 20, 50, 70, 100, 200, 500, 1000 times or less than 1000 timesto that of what is considered as clinically normal or to the levelobtained from a control. In some embodiments, high level is an mRNAlevel more than about 1.1, 1.2, 1.3, 1.5, 1.7, 2, 2.2, 2.5, 2.7, 3, 5,7, 10, 20, 50, 70, 100, 200, 500, 1000 times or more than 1000 times tothat of what is considered as clinically normal or to the level obtainedfrom a control.

In some embodiments, protein expression level is determined, for exampleby immunohistochemistry. For example, the criteria for low or highlevels can be made based on the number of positive staining cells and/orthe intensity of the staining, for example by using an antibody thatspecifically recognizes the mER protein. In some embodiments, the levelis low if less than about 1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%,45%, or 50% cells have positive staining. In some embodiments, the levelis low if the staining is 1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%,45%, or 50% less intense than a positive control staining.

In some embodiments, the level is high if more than about 40%, 45%, 50%,55%, 60%, 65%, 70%, 75%, 80%, 85%, or 90%, cells have positive staining.In some embodiments, the level is high if the staining is as intense aspositive control staining. In some embodiments, the level is high if thestaining is 80%, 85%, or 90% as intense as positive control staining.

In some embodiments, strong staining, moderate staining, and weakstaining are calibrated levels of staining, wherein a range isestablished and the intensity of staining is binned within the range. Insome embodiments, strong staining is staining above the 75th percentileof the intensity range, moderate staining is staining from the 25th tothe 75th percentile of the intensity range, and low staining is stainingis staining below the 25th percentile of the intensity range. In someaspects one skilled in the art, and familiar with a particular stainingtechnique, adjusts the bin size and defines the staining categories.

In some embodiments, estrogen sensitive level is determined, for exampleby Ca2+ oscillation or electrophysiological pathclamp. For example, thecriteria for low or high levels can be made based on the change of Ca2+concentration or responsive signal of positive cells, for example byusing estrogen. In some embodiments, the level is low if less than about1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, or 50% cells havepositive sensitivity. In some embodiments, the level is low if thechange of Ca2+ concentration or responsive signal is 1%, 5%, 10%, 15%,20%, 25%, 30%, 35%, 40%, 45%, or 50% less intense than a positivecontrol sensitivity.

In some embodiments, the level is high if more than about 40%, 45%, 50%,55%, 60%, 65%, 70%, 75%, 80%, 85%, or 90%, cells have positive change.In some embodiments, the level is high if the sensitivity is as intenseas positive control sensitivity. In some embodiments, the level is highif the change is 80%, 85%, or 90% as intense as positive control.

In some embodiments, most sensitivity, moderate sensitivity, and weaksensitivity are calibrated levels of Ca2+ signal in cells, wherein arange is established and the intensity of Ca2+ signal is binned withinthe range. In some embodiments, most sensitivity is the change of Ca2+signal above the 75th percentile of the intensity range, moderatesensitivity is the change of Ca2+ signal from the 25th to the 75thpercentile of the intensity range, and low sensitivity is the change ofCa2+ signal is measuring below the 25th percentile of the intensityrange. In some aspects one skilled in the art, and familiar with aparticular perfusion technique, adjusts the bin size and defines thesignal recording categories.

Methods of Reducing Postmenopausal Syndrome

In some embodiments, there are provided methods of reducing apostmenopausal symptom in an individual, comprising administering to theindividual an effective amount of an anordrin or analog thereof (such asanordrin).

In some embodiments, there are provided methods of reducing apostmenopausal symptom in an individual, comprising administering to theindividual: a) an effective amount of an anordrin or analog thereof(such as anordrin); and b) an effective amount of at least one otheragent is selected from the group consisting of raloxifene or functionalequivalent thereof and an aromatase inhibitor. In some embodiments, theanordrin or analog thereof (such as anordrin) and the other agent areadministered sequentially. In some embodiments, the anordrin or analogthereof (such as anordrin) and the other agent are administeredsimultaneously (for example in a single composition, such as thepharmaceutical compositions described herein).

Postmenopausal syndromes described herein include, but are not limitedto, fat liver, weight gain, high blood triglyceride, and osteoporosisand organ atrophy.

Thus, for example, in some embodiments, there is provided a method ofpreventing (or reducing symptoms of) osteoporosis in an individual,comprising administering to the individual an effective amount of ananordrin or analog thereof (such as anordrin). In some embodiments,there is provided a method of preventing (or reducing symptoms of)osteoporosis in an individual, comprising administering to theindividual: a) an effective amount of an anordrin or analog thereof(such as anordrin); and b) an effective amount of at least one otheragent, wherein the other agent is raloxifene or functional equivalentthereof. In some embodiments, the other agent is raloxifene. In someembodiments, the other agent is selected from the group consisting oftamoxifen, raloxifene, lasofoxifene, bazedoxifene, arzoxifene,ormeloxifene, ospemifene, and levormeloxifene. In some embodiments,there is provided a method of preventing (or reducing symptoms of)osteoporosis in an individual, comprising administering to theindividual: a) an effective amount of an anordrin or analog thereof(such as anordrin); and b) an effective amount of at least one otheragent, wherein the other agent is an aromatase inhibitor. In someembodiments, the other agent is anastrozole. In some embodiments, themethod further comprises administering to the individual an effectiveamount of calcium. Suitable amounts of calcium include, but are notlimited to, about 1 to about 500 mg/day, such as about 10 to about 200mg/day, about 50 to about 1500 mg/day. In some embodiments, the methodfurther comprises administering to the individual an effective amount ofvitamin D. Suitable amounts of vitamin D include, but are not limitedto, about 400 to about 800 IU/day, such as about 500 to about 600IU/day.

In some embodiments, there is provided a method of preventing (orreducing symptoms of) fatty liver in an individual, comprisingadministering to the individual an effective amount of an anordrin oranalog thereof (such as anordrin). In some embodiments, there isprovided a method of preventing (or reducing symptoms of) fatty liver inan individual, comprising administering to the individual; a) aneffective amount of an anordrin or analog thereof (such as anordrin);and b) an effective amount of at least one other agent, wherein theother agent is raloxifene or functional equivalent thereof in someembodiments, the other agent is raloxifene. In some embodiments, theother agent is selected from the group consisting of tamoxifen,raloxifene, lasofoxifene, bazedoxifene, arzoxifene, ormeloxifene,ospemifene, and levormeloxifene. In some embodiments, there is provideda method of preventing (or reducing symptoms of) fatty liver in anindividual, comprising administering to the individual: a) an effectiveamount of an anordrin or analog thereof (such as anordrin); and b) aneffective amount of at least one other agent, wherein the other agent isan aromatase inhibitor. In some embodiments, the other agent isanastrozole.

In some embodiments, there is provided a method of preventing (orreducing symptoms of) insulin resistance in an individual, comprisingadministering to the individual an effective amount of an anordrin oranalog thereof (such as anordrin). In some embodiments, there isprovided a method of preventing (or reducing symptoms of) insulinresistance in an individual, comprising administering to the individual:a) an effective amount of an anordrin or analog thereof (such asanordrin); and b) an effective amount of at least one other agent,wherein the other agent is raloxifene or functional equivalent thereof.In some embodiments, the other agent is raloxifene. In some embodiments,the other agent is selected from the group consisting of tamoxifen,raloxifene, lasofoxifene, bazedoxifene, arzoxifene, ormeloxifene,ospemifene, and levormeloxifene. In some embodiments, there is provideda method of preventing (or reducing symptoms of) insulin resistance inan individual, comprising administering to the individual: a) aneffective amount of an anordrin or analog thereof (such as anordrin);and b) an effective amount of at least one other agent, wherein theother agent is an aromatase inhibitor. In some embodiments, the otheragent is anastrozole.

In some embodiments, there is provided a method of reducing sugar uptakeor increasing cellular ATP concentrations or both in an individual,comprising administering to the individual an effective amount of ananordrin or analog thereof (such as anordrin). In some embodiments,there is provided a method of reducing sugar uptake or increasingcellular ATP concentrations or both in an individual, comprisingadministering to the individual: a) an effective amount of an anordrinor analog thereof (such as anordrin); and b) an effective amount of atleast one other agent, wherein the other agent is raloxifene orfunctional equivalent thereof. In some embodiments, the other agent israloxifene. In some embodiments, the other agent is selected from thegroup consisting of tamoxifen, raloxifene, lasofoxifene, bazedoxifene,arzoxifene, ormeloxifene, ospemifene, and levormeloxifene. In someembodiments, there is provided a method of reducing sugar uptake orincreasing cellular ATP concentrations or both in an individual,comprising administering to the individual: a) an effective amount of ananordrin or analog thereof (such as anordrin); and b) an effectiveamount of at least one other agent, wherein the other agent is anaromatase inhibitor. In some embodiments, the other agent isanastrozole.

In some embodiments, there is provided a method of preventing (orreducing symptoms of) organ atrophy in an individual, comprisingadministering to the individual an effective amount of an anordrin oranalog thereof (such as anordrin). In some embodiments, there isprovided a method of preventing (or reducing symptoms of) organ atrophyin an individual, comprising administering to the individual: a) aneffective amount of an anordrin or analog thereof (such as anordrin);and b) an effective amount of at least one other agent, wherein theother agent is raloxifene or functional equivalent thereof. In someembodiments, the other agent is raloxifene. In some embodiments, theother agent is selected from the group consisting of tamoxifen,raloxifene, lasofoxifene, bazedoxifene, arzoxifene, ormeloxifene,ospemifene, and levormeloxifene. In some embodiments, there is provideda method of preventing (or reducing symptoms of) organ atrophy in anindividual, comprising administering to the individual: a) an effectiveamount of an anordrin or analog thereof (such as anordrin); and b) aneffective amount of at least one other agent, wherein the other agent isan aromatase inhibitor. In some embodiments, the other agent isanastrozole.

In some embodiments, there is provided a method of preventing (orreducing symptoms of) weight gain in an individual, comprisingadministering to the individual an effective amount of an anordrin oranalog thereof (such as anordrin). In some embodiments, there isprovided a method of preventing (or reducing symptoms of) weight gain inan individual, comprising administering to the individual: a) aneffective amount of an anordrin or analog thereof (such as anordrin);and b) an effective amount of at least one other agent, wherein theother agent is raloxifene or functional equivalent thereof. In someembodiments, the other agent is raloxifene. In some embodiments, theother agent is selected from the group consisting of tamoxifen,raloxifene, lasofoxifene, bazedoxifene, arzoxifene, ormeloxifene,ospemifene, and levormeloxifene. In some embodiments, there is provideda method of preventing (or reducing symptoms of) weight gain in anindividual, comprising administering to the individual: a) an effectiveamount of an anordrin or analog thereof (such as anordrin); and b) aneffective amount of at least one other agent, wherein the other agent isan aromatase inhibitor. In some embodiments, the other agent isanastrozole.

In some embodiments, there is provided a method of reducing bloodtriglyceride in an individual, comprising administering to theindividual an effective amount of an anordrin or analog thereof (such asanordrin). In some embodiments, there is provided a method of reducingblood triglyceride in an individual, comprising administering to theindividual: a) an effective amount of an anordrin or analog thereof(such as anordrin); and b) an effective amount of at least one otheragent, wherein the other agent is raloxifene or functional equivalentthereof. In some embodiments, the other agent is raloxifene. In someembodiments, the other agent is selected from the group consisting oftamoxifen, raloxifene, lasofoxifene, bazedoxifene, arzoxifene,ormeloxifene, ospemifene, and levormeloxifene. In some embodiments,there is provided a method of reducing blood triglyceride in anindividual, in an individual, comprising administering to theindividual: a) an effective amount of an anordrin or analog thereof(such as anordrin); and b) an effective amount of at least one otheragent, wherein the other agent is an aromatase inhibitor. In someembodiments, the other agent is anastrozole.

In some embodiments, there is provided a method of reducing bloodviscosity and/or thromboembolism in an individual, comprisingadministering to the individual an effective amount of an anordrin oranalog thereof (such as anordrin). In some embodiments, there isprovided a method of reducing blood viscosity and/or thromboembolism inan individual, comprising administering to the individual: a) aneffective amount of an anordrin or analog thereof (such as anordrin);and b) an effective amount of at least one other agent, wherein theother agent is raloxifene or functional equivalent thereof. In someembodiments, the other agent is raloxifene. In some embodiments, theother agent is selected from the group consisting of tamoxifen,raloxifene, lasofoxifene, bazedoxifene, arzoxifene, ormeloxifene,ospemifene, and levormeloxifene. In some embodiments, there is provideda method of reducing blood viscosity and/or thromboembolism in anindividual, in an individual, comprising administering to theindividual: a) an effective amount of an anordrin or analog thereof(such as anordrin); and b) an effective amount of at least one otheragent, wherein the other agent is an aromatase inhibitor. In someembodiments, the other agent is anastrozole.

Modes of Administration

In the context of combination therapy, the composition comprisinganordrin or analog thereof (such as anordrin) and the other agent can beadministered simultaneously (i.e., simultaneous administration) and/orsequentially (i.e., sequential administration). In some embodiments, theanordrin or analog thereof (such as anordrin) and the other agent(including the specific agents described herein) are administeredsimultaneously. The term “simultaneous administration.” as used herein,means that the anordrin or analog thereof (such as anordrin) and theother agent are administered with a time separation of no more thanabout 15 minute(s), such as no more than about any of 10, 5, or 1minutes. When the drugs are administered simultaneously, the anordrin oranalog thereof (such as anordrin) and the other agent may be containedin the same composition (e.g., a composition comprising both theanordrin or analog thereof (such as anordrin) and the other agent, forexample the pharmaceutical composition comprised herein) or in separatecompositions (e.g., the anordrin or analog thereof (such as anordrin)and the other agent are contained in separate compositions).

In some embodiments, the anordrin or analog thereof (such as anordrin)and the other agent are administered sequentially. The term “sequentialadministration” as used herein means that the drug in the anordrin oranalog thereof (such as anordrin) and the other agent are administeredwith a time separation of more than about 15 minutes, such as more thanabout any of 20, 30, 40, 50, 60 or more minutes. Either the anordrin oranalog thereof (such as anordrin) or the other agent may be administeredfirst. The anordrin or analog thereof (such as anordrin) and the otheragent are contained in separate compositions, which may be contained inthe same or different packages.

In some embodiments, the administration of the anordrin or analogthereof (such as anordrin) and the other agent are concurrent, i.e., theadministration period of the anordrin or analog thereof (such asanordrin) and that of the other agent overlap with each other. In someembodiments, the anordrin or analog thereof (such as anordrin) isadministered for at least one cycle (for example, at least any of 2, 3,or 4 cycles) prior to the administration of the other agent. In someembodiments, the other agent is administered for at least any of one,two, three, or four weeks. In some embodiments, the administrations ofthe anordrin or analog thereof (such as anordrin) and the other agentare initiated at about the same time (for example, within any one of 1,2, 3, 4, 5, 6, or 7 days). In some embodiments, the administrations ofthe anordrin or analog thereof (such as anordrin) and the other agentare terminated at about the same time (for example, within any one of 1,2, 3, 4, 5, 6, or 7 days). In some embodiments, the administration ofthe other agent continues (for example for about any one of 1, 2, 3, 4,5, 6, 7, 8, 9, 10, 11, or 12 months) after the termination of theadministration of the anordrin or analog thereof (such as anordrin). Insome embodiments, the administration of the other agent is initiatedafter (for example after about any one of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10,11, or we months) the initiation of the administration of the anordrinor analog thereof (such as anordrin). In some embodiments, theadministrations of the anordrin or analog thereof (such as anordrin) andthe other agent are initiated and terminated at about the same time. Insome embodiments, the administrations of the anordrin or analog thereof(such as anordrin) and the other agent are initiated at about the sametime and the administration of the other agent continues (for examplefor about any one of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 months)after the termination of the administration of the anordrin or analogthereof (such as anordrin). In some embodiments, the administration ofthe anordrin or analog thereof (such as anordrin) and the other agentstop at about the same time and the administration of the other agent isinitiated after (for example after about any one of 1, 2, 3, 4, 5, 6, 7,8, 9, 10, 11, or we months) the initiation of the administration of theanordrin or analog thereof (such as anordrin).

The dosing frequency of the anordrin or analog thereof (such asanordrin) and/or the other agent may be adjusted over the course of thetreatment, based on the judgment of the administering physician. Whenadministered separately, the anordrin or analog thereof (such asanordrin) and the other agent can be administered at different dosingfrequency or intervals. For example, the anordrin or analog thereof(such as anordrin) can be administered weekly, while another agent canbe administered more or less frequently. Various formulations anddevices for achieving sustained release are known in the art. Exemplarydosing frequencies are further provided herein.

The anordrin or analog thereof (such as anordrin) and the other agentcan be administered using the same route of administration or differentroutes of administration. Exemplary administration routes are furtherprovided herein. In some embodiments (for both simultaneous andsequential administrations), the anordrin or analog thereof (such asanordrin) and the other agent are administered at a predetermined ratio.For example, in some embodiments, the ratio by weight of the anordrin oranalog thereof (such as anordrin) and the other agent is about 1 to 1.In some embodiments, the weight ratio may be between about 0.001 toabout 1 and about 1000 to about 1, or between about 0.01 to about 1 and100 to about 1. In some embodiments, the ratio by weight of the anordrinor analog thereof (such as anordrin) and the other agent is less thanabout any of 100:1, 50:1, 30:1, 10:1, 9:1, 8:1, 7:1, 6:1, 5:1, 4:1, 3:1,2:1, and 1:1. In some embodiments, the ratio by weight of the anordrinor analog thereof (such as anordrin) and the other agent is more thanabout any of 1:1, 2:1, 3:1, 4:1, 5:1, 6:1, 7:1, 8:1, 9:1, 30:1, 50:1,100:1. Other ratios are contemplated.

The doses required for the anordrin or analog thereof (such as anordrin)and/or the other agent may (but not necessarily) be lower than what isnormally required when each agent is administered alone. Thus, in someembodiments, a subtherapeutic amount of the drug in the anordrin oranalog thereof (such as anordrin) and/or the other agent areadministered. “Subtherapeutic amount” or “subtherapeutic level” refer toan amount that is less than therapeutic amount, that is, less than theamount normally used when the drug in the anordrin or analog thereof(such as anordrin) and/or the other agent are administered alone. Thereduction may be reflected in terms of the amount administered at agiven administration and/or the amount administered over a given periodof time (reduced frequency).

In some embodiments, enough other agent is administered so as to allowreduction of the normal dose of the anordrin or analog thereof (such asanordrin) required to effect the same degree of treatment by at leastabout any of 5%, 10%, 20%, 30%, 50%, 60%, 70%, 80%, 90%, or more. Insome embodiments, enough anordrin or analog thereof (such as anordrin)is administered so as to allow reduction of the normal dose of the otheragent required to effect the same degree of treatment by at least aboutany of 5, 10%, 20%, 30%, 50%, 60%, 70%, 80%, 90%, or more.

In some embodiments, the doses of both the anordrin or analog thereof(such as anordrin) and the other agent are reduced as compared to thecorresponding normal dose of each when administered alone. In someembodiments, both the anordrin or analog thereof (such as anordrin) andthe other agent are administered at a subtherapeutic, i.e., reduced,level. In some embodiments, the dose of the anordrin or analog thereof(such as anordrin) and/or the other agent is substantially less than theestablished maximum toxic dose (MTD). For example, the dose of theanordrin or analog thereof (such as anordrin) and/or the other agent isless than about 50%, 40%, 30%, 20%, or 10% of the MTD.

In some embodiments, the dose of anordrin or analog thereof (such asanordrin) and/or the dose of the other agent is higher than what isnormally required when each agent is administered alone. For example, insome embodiments, the dose of the anordrin or analog thereof (such asanordrin) and/or the other agent is substantially higher than theestablished maximum toxic dose (MTD). For example, the dose of theanordrin or analog thereof (such as anordrin) and/or the other agent ismore than about 50%, 40%, 30%, 20%, or 10% of the MTD of the agent whenadministered alone.

In some embodiments, the amount of a anordrin or analog thereof (such asanordrin) (alone or in combination with an other agent) is included inany of the following ranges: about 0.1 to about 0.5 mg, about 0.5 toabout 5 mg, about 5 to about 10 mg, about 10 to about 15 mg, about 15 toabout 20 mg, about 20 to about 25 mg, about 20 to about 50 mg, about 25to about 50 mg, about 50 to about 75 mg, about 50 to about 100 mg, about75 to about 100 mg, about 100 to about 125 mg, about 125 to about 150mg, about 150 to about 175 mg, about 175 to about 200 mg, about 200 toabout 225 mg, about 225 to about 250 mg, about 250 to about 300 mg,about 300 to about 350 mg, about 350 to about 400 mg, about 400 to about450 mg, or about 450 to about 500 mg. In some embodiments, the amount ofa anordrin or analog thereof (such as anordrin) (e.g., a unit dosageform) is in the range of about 5 mg to about 500 mg, such as about 30 mgto about 300 mg or about 50 mg to about 200 mg.

In some embodiments, the amount of the anordrin or analog thereof (suchas anordrin) (alone or in combination with another agent) includes atleast about any of 0.01 mg/kg, 0.05 mg/kg, 0.1 mg/kg, 0.25 mg/kg, 0.5mg/kg, 1 mg/kg, 2.5 mg/kg, 3.5 mg/kg, 5 mg/kg, 6.5 mg/kg, 7.5 mg/kg, 10mg/kg, 15 mg/kg or 20 mg/kg. In some embodiments, the amount of theanordrin or analog thereof (such as anordrin) (alone or in combinationwith another agent) includes at least about any of 0.01 mg/kg/day, 0.05mg/kg/day, 0.1 mg/kg/day, 0.25 mg/kg/day, 0.5 mg/kg/day, 1 mg/kg/day,2.5 mg/kg/day, 3.5 mg/kg/day, 5 mg/kg/day, 6.5 mg/kg/day, 7.5 mg/kg/day,10 mg/kg/day, 15 mg/kg/day or 20 mg/kg/day.

In some embodiments, the amount of the other agent includes at leastabout any of 0.01 mg/kg, 0.05 mg/kg, 0.1 mg/kg, 0.25 mg/kg, 0.5 mg/kg, 1mg/kg, 2.5 mg/kg, 3.5 mg/kg, 5 mg/kg, 6.5 mg/kg, 7.5 mg/kg, 10 mg/kg, 15mg/kg or 20 mg/kg. In some embodiments, the amount of the anordrin oranalog thereof (such as anordrin) (alone or in combination with anotheragent) includes at least about any of 0.01 mg/kg/day, 0.05 mg/kg/day,0.1 mg/kg/day, 0.25 mg/kg/day, 0.5 mg/kg/day, 1 mg/kg/day, 2.5mg/kg/day, 3.5 mg/kg/day, 5 mg/kg/day, 6.5 mg/kg/day, 7.5 mg/kg/day, 10mg/kg/day, 15 mg/kg/day or 20 mg/kg/day.

Exemplary dosing frequencies for the anordrin or analog thereof (such asanordrin) (and for the other agent) include, but are not limited to,once every 2 weeks, once every 3 weeks, once every 4 weeks, once every 6weeks, or once every 8 weeks. In some embodiments, the composition isadministered at least about any of 1×, 2×, 3×, 4×, 5×, 6×, or 7× (i.e.,daily) a week, or three times daily, two times daily. In someembodiments, the intervals between each administration are less thanabout any of 6 months, 3 months, 1 month, 20 days, 15 days, 12 days, 10days, 9 days, 8 days, 7 days, 6 days, 5 days, 4 days, 3 days, 2 days, or1 day. In some embodiments, the intervals between each administrationare more than about any of 1 month, 2 months, 3 months, 4 months, 5months, 6 months, 8 months, or 12 months. In some embodiments, there isno break in the dosing schedule. In some embodiments, the intervalbetween each administration is no more than about a week.

The administration of the anordrin or analog thereof (such as anordrin)(and for the other agent) can be extended over an extended period oftime, such as from about a month up to about seven years. In someembodiments, the composition is administered over a period of at leastabout any of 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 18, 24, 30, 36, 48, 60,72, or 84 months.

In some embodiments, the individual is treated for at least about any ofone, two, three, four, five, six, seven, eight, nine, or ten treatmentcycles.

The dosing frequency of the other agent can be the same or differentfrom that of the anordrin or analog thereof (such as anordrin).Exemplary frequencies are provided above.

The anordrin or analog thereof (such as anordrin) (and the other agent)described herein can be administered to an individual (such as human)via various routes, including, for example, oral, intravenous,intra-arterial, intraperitoneal, intrapulmonary, inhalation,intravesicular, intramuscular, intra-tracheal, subcutaneous,intraocular, intrathecal, transmucosal, and transdermal. In someembodiments, sustained continuous release formulation of the compositionmay be used.

A combination of the administration configurations described herein canbe used. The combination therapy methods described herein may beperformed alone or in conjunction with another therapy, such as surgery,radiation, chemotherapy, immunotherapy, gene therapy, and the like.Additionally, a person having a greater risk of developing theproliferative disease may receive treatments to inhibit or and/or delaythe development of the disease.

As will be understood by those of ordinary skill in the art, theappropriate doses of other agents will be approximately those alreadyemployed in clinical therapies wherein the other agent are administeredalone or in combination with other agents. Variation in dosage willlikely occur depending on the condition being treated. As describedabove, in some embodiments, the other agents may be administered at areduced level.

Compositions, Kits, and Medicines

The invention also provides compositions (such as pharmaceuticalcompositions), medicine, kits, and unit dosages useful for methodsdescribed herein. Also provided are any use described herein whether inthe context of use as a medicament and/or use for manufacture of amedicament.

The methods of the present application comprise administration ofanordrin or analog thereof (such as anordrin). Suitable anordrin oranalogs thereof are described in more details below.

The methods of the present application in some aspects compriseadministration of raloxifene or functional equivalent thereof.“Functional equivalent thereof” used herein refers to compounds thatfunctions through the same mechanism as raloxifene. For example,functional equivalents of raloxifene include, but are not limited to,lasofoxifene, bazedoxifene, arzoxifene, ormeloxifene, ospemifene, andlevormeloxifene.

In another aspect, the method comprises administration of an aromataseinhibitor. “Aromatase inhibitor” refers to a class of agents thatinhibit aromatase activity. Aromatase inhibitors have been used in thetreatment of breast cancer and ovarian cancer in postmenopausal women toreduce increase of estrogen conversion during cycle with externaltestosterone. Suitable aromatase inhibitors include, but are not limitedto, anastrozole (Arimidex), letrozole (Femara), exemestane (Aromasin),vorozole (Rivizor), formestane (Lentaron), and fadrozole (Afema).

In another aspect, there is provided a pharmaceutical compositioncomprising an anordrin or analog thereof (such as anordrin) and at leastone other agent selected from the group consisting of tamoxifen,raloxifene or functional equivalent thereof, and an aromatase inhibitor.In some embodiments, there is provided a pharmaceutical compositioncomprising an anordrin or analog thereof (such as anordrin) and at leastone other agent, wherein the other agent is tamoxifen. In someembodiments, there is provided a pharmaceutical composition comprisingan anordrin or analog thereof (such as anordrin) and at least one otheragent, wherein the other agent is raloxifene. In some embodiments, thereis provided a pharmaceutical composition comprising an anordrin oranalog thereof (such as anordrin) and at least one other agent, whereinthe other agent is anastrozole.

In some embodiments, the pharmaceutical composition further comprises alipid, which includes, but is not limited to, corn oil. The lipid can bepresent, for example, in the amount of about 1%-5% (w/w).

In some embodiments, the pharmaceutical composition further comprisesprotein (such as casein). Protein (such as casein) can be present, forexample, in the amount of about 5%-50% (w/w).

In some embodiments, the ratio by weight of the anordrin or analogthereof (such as anordrin) and the other agent in the composition isabout 1 to 1. In some embodiments, the weight ratio is between about0.001 to about 1 and about 1000 to about 1, or between about 0.01 toabout 1 and 100 to about 1. In some embodiments, the ratio by weight ofthe anordrin or analog thereof (such as anordrin) and the other agent isless than about any of 100:1, 50:1, 30:1, 10:1, 9:1, 8:1, 7:1, 6:1, 5:1,4:1, 3:1, 2:1, and 1:1 In some embodiments, the ratio by weight of theanordrin or analog thereof (such as anordrin) and the other agent ismore than about any of 1:1, 2:1, 3.1, 4:1, 5:1, 6:1, 7:1, 8:1, 9:1,30:1, 50:1, 100:1. In some embodiments, the weight ratio of anordrin oranalog thereof (such as anordrin) and the other agent in the compositionis about 1:20 to about 20:1 (including for example about 10:1 to about1:10, or about 1:10 to about 1:15).

The composition in some embodiments may be present in a unit dosage form(such as an oral unit dosage form). Suitable unit dosage forms include,but are not limited to, capsules, tablets, pills, caplets, gels, liquids(e.g., suspensions, solutions, emulsions), powders or otherparticulates, and so forth.

In another aspect, there are provided kits comprising anordrin or analogthereof (such as anordrin) and the other agent either in separatecontainers or in the same container. Kits of the invention include oneor more containers comprising anordrin or analog thereof (such asanordrin) (or unit dosage forms and/or articles of manufacture) and/orat least one other agent, and in some embodiments, further compriseinstructions for use in accordance with any of the methods describedherein. The kit may further comprise a description of selection anindividual suitable or treatment. Instructions supplied in the kits ofthe invention are typically written instructions on a label or packageinsert (e.g., a paper sheet included in the kit), but machine-readableinstructions (e.g., instructions carried on a magnetic or opticalstorage disk) are also acceptable.

In some embodiments, the kit comprises a) an effective amount ananordrin or analog thereof (such as anordrin), and b) an effectiveamount of at least one other agent selected from the group consisting oftamoxifen, raloxifene or functional equivalent thereof, and an aromataseinhibitor. In some embodiments, the kit comprises: a) an effectiveamount an anordrin or analog thereof (such as anordrin), and b) aneffective amount of at least one other agent selected from the groupconsisting of tamoxifen, raloxifene or functional equivalent thereof,and an aromatase inhibitor, and c) instructions for administering theanordrin or analog thereof (such as anordrin) and the other agentssimultaneously, sequentially, or concurrently for treatment of cancer(or other uses described herein).

The anordrin or analog thereof (such as anordrin) and the other agentscan be present in separate containers or in a single container ht isunderstood that the kit may comprise one distinct composition or two ormore compositions wherein one composition comprises anordrin or analogthereof (such as anordrin) and one composition comprises another agent.

The kits of the invention are in suitable packaging. Suitable packaginginclude, but is not limited to, vials, bottles, jars, flexible packaging(e.g., sealed Mylar or plastic bags), and the like. Kits may optionallyprovide additional components such as buffers and interpretativeinformation. The present application thus also provides articles ofmanufacture, which include vials (such as sealed vials), bottles, jars,flexible packaging, and the like.

The instructions relating to the use of the anordrin or analog thereof(such as anordrin) generally include information as to dosage, dosingschedule, and route of administration for the intended treatment. Thecontainers may be unit doses, bulk packages (e.g., multi-dose packages)or sub-unit doses. For example, kits may be provided that containsufficient dosages of the anordrin or analog thereof (such as anordrin)(such as anordrin or analog thereof (such as anordrin)) as disclosedherein to provide effective treatment of an individual for an extendedperiod, such as any of a week, 2 weeks, 3 weeks, 4 weeks, 6 weeks, 8weeks, 3 months, 4 months, 5 months, 7 months, 8 months, 9 months, ormore. Kits may also include multiple unit doses of the anordrin oranalog thereof (such as anordrin) and pharmaceutical compositions andinstructions for use and packaged in quantities sufficient for storageand use in pharmacies, for example, hospital pharmacies and compoundingpharmacies.

Anordrin and its Analogs

The present application provides methods and compositions comprisinganordrin or its analogs.

In some embodiments, the anordrin or analog therefore has the structureof Formula (I),

wherein

-   -   R¹ is hydroxyl or —O(CO)R^(1a), wherein R^(1a) is C₁-C₄alkyl;    -   R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁-C₁₂alkyl,C₂-C₁₂alkenyl, or phenyl;

-   -   R⁴ is hydroxyl or —O(CO)R^(4a), wherein R^(4a) is C₁-C₄alkyl;    -   R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl,C₂-C₁₂alkenyl, or phenyl;

-   -   R⁶ is C₁-C₆alkyl or C₂-C₆alkenyl; and    -   R⁷ is C₁-C₆alkyl or C₂-C₆alkenyl;    -   or a pharmaceutically acceptable salt thereof.

In some embodiments, Formula (I) is Formula (Ia):

In some embodiments, Formula (I) is Formula (Ib):

In some embodiments, R¹ is —O(CO)R^(1a), wherein R^(1a) is C₁-C₄alkyl(e.g., C₁alkyl, C₂alkyl, C₃alkyl, or C₄alkyl). In some embodiments,R^(1a) is C₁-C₄alkyl, such as C₁-C₃alkyl or C₁-C₂alkyl. In someembodiments, R^(1a) is methyl. In some embodiments, R^(1a) is ethyl. Insome embodiments, R¹ is hydroxyl.

In some embodiments, R² is

In some embodiments, R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R^(2a) and R^(2b) are independently hydrogen,C₁-C₁₂alkyl, or C₂-C₁₂alkenyl. In some embodiments, R^(2a) and R^(2b)are independently hydrogen or C₁-C₁₂alkyl. In some embodiments, R^(2a)and R^(2b) are independently hydrogen or C₂-C₁₂alkenyl.

In some embodiments, R^(2a) and R^(2b) are independently hydrogen,C₁-C₄alkyl, or C₂-C₄alkenyl. In some embodiments, R^(2a) and R^(2b) areindependently hydrogen or C₁-C₄alkyl. In some embodiments, R^(2a) andR^(2b) are independently hydrogen or C₂-C₄alkenyl.

In some embodiments, R^(2a) and R^(2b) are independently hydrogen,C₁₀-C₁₂alkyl, or C₁₀-C₁₂alkenyl. In some embodiments, R^(2a) and R^(2b)are independently hydrogen or C₁₀-C₁₂alkyl. In some embodiments, R^(2a)and R^(2b) are independently hydrogen or C₁₀-C₁₂alkenyl.

In some embodiments, R^(2a) is hydrogen and R^(2b) is C₁-C₁₂alkyl, suchas C₁-C₄alkyl, C₁-C₃alkyl, C₁-C₂alkyl, or C₁₀-C₁₂alkyl. In someembodiments, R^(2a) is hydrogen and R^(2b) is C₂-C₁₂alkenyl, such asC₂-C₄alkenyl, C₂-C₃alkenyl, C₂alkenyl, or C₁₀-C₁₂alkenyl.

In some embodiments, R⁴ is —O(CO)R^(1a), wherein R^(4a) is C₁-C₄alkyl(e.g., C₁alkyl, C₂alkyl, C₃alkyl, or C₄alkyl). In some embodiments,R^(4a) is C₁-C₄alkyl, such as C₁-C₃alkyl or C₁-C₂alkyl. In someembodiments, R^(4a) is methyl. In some embodiments, R^(4a) is ethyl. Insome embodiments, R⁴ is hydroxyl.

In some embodiments, R⁵ is

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R^(5a) and R^(5b) are independently hydrogen,C₁-C₁₂alkyl, or C₂-C₁₂alkenyl. In some embodiments, R^(5a) and R^(5b)are independently hydrogen or C₁-C₁₂alkyl. In some embodiments, R^(5a)and R^(5b) are independently hydrogen or C₁-C₁₂alkenyl.

In some embodiments, R^(5a) and R^(5b) are independently hydrogen,C₁-C₄alkyl, or C₂-C₄alkenyl. In some embodiments, R^(5a) and R^(5b) areindependently hydrogen or C₁-C₄alkyl. In some embodiments, R^(5a) andR^(5b) are independently hydrogen or C₂-C₄alkenyl.

In some embodiments, R^(5a) and R^(5b) are independently hydrogen,C₁₀-C₁₂alkyl, or C₁₀-C₁₂alkenyl. In some embodiments, R^(5a) and R^(5b)are independently hydrogen or C₁₀-C₁₂ alkyl. In some embodiments, R^(5a)and R^(5b) are independently hydrogen or C₁₀-C₁₂alkenyl.

In some embodiments, R^(5a) is hydrogen and R^(5b) is C₁-C₁₂alkyl, suchas C₁-C₄alkyl, C₁-C₃alkyl, C₁-C₂alkyl, or C₁₀-C₁₂alkyl. In someembodiments, R^(5a) is hydrogen and R^(5b) is C₂-C₁₂alkenyl, such asC₂-C₄alkenyl, C₂-C₃alkenyl, C₂alkenyl, or C₁₀-C₁₂alkenyl.

In some embodiments, R⁶ is C₁-C₆alkyl (e.g., C₁alkyl, C₂alkyl, C₃alkyl,C₄alkyl, C₅alkyl, or C₆alkyl). In some embodiments, R⁶ is C₁-C₆alkyl,such as C₁-C₃alkyl or C₁-C₂alkyl. In some embodiments, R⁶ is methyl. Insome embodiments, R⁶ is ethyl. In some embodiments, R⁶ is C₂-C₆alkenyl(e.g., C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, or C₆alkenyl).

In some embodiments, R⁷ is C₁-C₆alkyl (e.g., C₁alkyl, C₂alkyl, C₃alkyl,C₄alkyl, C₅alkyl, or C₆alkyl). In some embodiments, R⁷ is C₁-C₆alkyl,such as C₁-C₃alkyl, C₁-C₂alkyl, or C₃-C₆alkyl. In some embodiments, R⁷is methyl. In some embodiments, R⁷ is ethyl. In some embodiments, R⁷ isC₁-C₂alkyl. In some embodiments, R⁷ is C₃-C₆alkyl.

In some embodiments, the compounds may have any one or more of thefollowing structural features. In some embodiments, R¹ and R⁴ are samemoiety and R² and R⁵ are the same moiety.

-   -   a) R¹ is —O(CO)R^(1a), wherein R^(1a) is C₁-C₄alkyl;    -   b) R⁴ is —O(CO)R^(4a), wherein R^(4a) is C₁-C₄alkyl;    -   c) R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁-C₄alkyl or C₁₀-C₁₂alkyl), C₂-C₁₂alkenyl (e.g., C₂-C₄alkenyl orC₁₀-C₁₂alkenyl), or phenyl; and

-   -   d) R⁵ is

or wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl(e.g., C₁-C₄alkyl or C₁₀-C₁₂alkyl), C₂-C₁₂alkenyl (e.g., C₂-C₄alkenyl orC₁₀-C₁₂alkenyl), or phenyl.

In some embodiments, the compounds may have any one or more of thefollowing structural features. In some embodiments, R¹ and R⁴ are samemoiety.

-   -   a) R¹ is —O(CO)R^(1a), wherein R^(1a) is C₁-C₄alkyl;    -   b) R⁴ is —O(CO)R^(4a), wherein R^(4a) is C₁-C₄alkyl;    -   c) R² is

and

-   -   d) R⁵ is

In some embodiments, the compounds may have any one or more of thefollowing structural features. In some embodiments, R¹ and R⁴ are samemoiety and R² and R⁵ are the same moiety.

-   -   a) R¹ is —O(CO)R^(1a), wherein R^(1a) is C₁-C₄alkyl;    -   b) R⁴ is —O(CO)R^(4a), wherein R^(4a) is C₁-C₄alkyl;    -   c) R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁-C₄alkyl,C₂-C₄alkenyl, or phenyl; and

-   -   d) R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₄alkyl,C₂-C₄alkenyl, or phenyl.

In some embodiments, the compounds may have any one or more of thefollowing structural features. In some embodiments, R¹ and R⁴ are samemoiety and R² and R⁵ are the same moiety.

-   -   a) R¹ is —O(CO)R^(1a), wherein R^(1a) is C₁-C₄alkyl;    -   b) R⁴ is —O(CO)R^(4a), wherein R^(4a) is C₁-C₄alkyl;    -   c) R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁₀-C₁₂alkyl,C₁₀-C₁₂alkenyl, or phenyl; and

-   -   d) R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen. C₁₀-C₁₂alkyl,C₁₀-C₁₂alkenyl, or phenyl.

In some embodiments, the compounds may have any one or more of thefollowing structural features. In some embodiments, R² and R⁵ are thesame moiety.

-   -   a) R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁-C₄alkyl or C₁₀-C₁₂alkyl), C₂-C₁₂alkenyl (e.g., C₂-C₄alkenyl orC₁₀-C₁₂alkenyl), or phenyl;

-   -   b) R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁-C₄alkyl or C₁₀-C₁₂alkyl), C₂-C₁₂alkenyl (e.g., C₂-C₄alkenyl orC₁₀-C₁₂alkenyl), or phenyl;

-   -   c) R¹ is hydroxyl; and    -   d) R⁴ is hydroxyl.

In some embodiments, the compounds may have any one or more of thefollowing structural features. In some embodiments, R² and R⁵ are thesame moiety.

-   -   a) R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁-C₄alkyl,C₂-C₄alkenyl, or phenyl;

-   -   b) R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₄alkyl,C₂-C₄alkenyl, or phenyl;

-   -   c) R¹ is hydroxyl; and    -   d) R⁴ is hydroxyl.

In some embodiments, the compounds may have any one or more of thefollowing structural features. In some embodiments, R² and R⁵ are thesame moiety.

-   -   a) R² is

wherein R^(2a) and R^(2b) are independently hydrogen, C₁₀-C₁₂alkyl,C₁₀-C₁₂alkenyl, or phenyl;

-   -   b) R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁₀-C₁₂alkyl,C₁₀-C₁₂alkenyl, or phenyl;

-   -   c) R¹ is hydroxyl; and    -   d) R⁴ is hydroxyl.

In some embodiments, the compounds may have any one or more of thefollowing structural features:

-   -   a) R⁶ is C₁-C₆alkyl (e.g., methyl or ethyl); and    -   b) R⁷ is methyl or ethyl.

In some embodiments, the anordrin or analog thereof has the structure ofFormula (II),

-   -   wherein    -   R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl,C₂-C₁₂alkenyl, or phenyl; and

-   -   R⁶ is C₁-C₆alkyl or C₂-C₆alkenyl;    -   or a pharmaceutically acceptable salt thereof.

In some embodiments, Formula (II) is Formula (IIa):

In some embodiments, Formula (I) is Formula (IIb):

In some embodiments, R⁵ is

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R^(5a) and R^(5b) are independently hydrogen,C₁-C₁₂alkyl, or C₁-C₁₂alkenyl. In some embodiments, R^(5a) and R^(5b)are independently hydrogen or C₁-C₁₂alkyl. In some embodiments, R^(5a)and R^(5b) are independently hydrogen or C₂-C₁₂alkenyl.

In some embodiments, R^(5a) and R^(5b) are independently hydrogen,C₁-C₄alkyl, or C₂-C₄alkenyl. In some embodiments, R^(5a) and R^(6b) areindependently hydrogen or C₁-C₄alkyl. In some embodiments, R^(5a) andR^(5b) are independently hydrogen or C₂-C₄alkenyl.

In some embodiments, R^(5a) and R^(5b) are independently hydrogen,C₁₀-C₁₂alkyl, or C₁₀-C₁₂alkenyl. In some embodiments, R^(5a) and R^(5b)are independently hydrogen or C₁₀-C₁₂alkyl. In some embodiments, R^(5a)and R^(5b) are independently hydrogen or C₁₀-C₁₂alkenyl.

In some embodiments, R^(5a) is hydrogen and R^(5b) is C₁-C₁₂alkyl, suchas C₁-C₄alkyl, C₁-C₃alkyl, C₁-C₂alkyl, or C₁₀-C₁₂alkyl. In someembodiments, R^(5a) is hydrogen and R^(5b) is C₂-C₁₂alkenyl, such asC₂-C₄alkenyl, C₂-C₃alkenyl, C₂alkenyl, or C₁₀-C₁₂alkenyl.

In some embodiments, R⁶ is C₁-C₆alkyl (e.g., C₁alkyl, C₂alkyl, C₃alkyl,C₄alkyl, C₅alkyl, or C₆alkyl). In some embodiments, R⁶ is C₁-C₆alkyl,such as C₁-C₃alkyl or C₁-C₂alkyl. In some embodiments, R⁶ is methyl. Insome embodiments, R⁶ is ethyl. In some embodiments, R⁶ is C₂-C₆alkenyl(e.g., C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, or C₆alkenyl).

In some embodiments, the anordrin or analog therefore has a structure ofFormula (III),

-   -   wherein    -   R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl,C₂-C₁₂alkenyl, or phenyl;

-   -   or a pharmaceutically acceptable salt thereof.

In some embodiments, Formula (III) is Formula (IIIa):

In some embodiments, Formula (III) is Formula (IIIb):

In some embodiments, R⁵ is

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R⁵ is

wherein R^(5a) and R^(5b) are independently hydrogen, C₁-C₁₂alkyl (e.g.,C₁alkyl, C₂alkyl, C₃alkyl, C₄alkyl, C₅alkyl, C₆alkyl, C₇alkyl, C₈alkyl,C₉alkyl, C₁₀alkyl, C₁₁alkyl, or C₁₂alkyl), C₂-C₁₂alkenyl (e.g.,C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, C₆alkenyl, C₇alkenyl,C₈alkenyl, C₉alkenyl, C₁₀alkenyl, C₁₁alkenyl, or C₁₂alkenyl), or phenyl.

In some embodiments, R^(5a) and R^(5b) are independently hydrogen,C₁-C₁₂alkyl, or C₂-C₁₂alkenyl. In some embodiments, R^(5a) and R^(5b)are independently hydrogen or C₁-C₁₂alkyl. In some embodiments, R^(5a)and R^(5b) are independently hydrogen or C₁-C₁₂alkenyl.

In some embodiments, R^(5a) and R^(5b) are independently hydrogen,C₁-C₄alkyl, or C₂-C₄alkenyl. In some embodiments, R^(5a) and R^(5b) areindependently hydrogen or C₁-C₄alkyl. In some embodiments, R^(5a) andR^(5b) are independently hydrogen or C₂-C₄alkenyl.

In some embodiments, R^(5a) and R^(5b) are independently hydrogen,C₁₀-C₁₂alkyl, or C₁₀-C₁₂alkenyl. In some embodiments, R^(5a) and R^(5b)are independently hydrogen or C₁₀-C₁₂alkyl. In some embodiments, R^(5a)and R^(5b) are independently hydrogen or C₁₀-C₁₂alkenyl.

In some embodiments, R^(5a) is hydrogen and R^(5b) is C₁-C₁₂alkyl, suchas C₁-C₄alkyl, C₁-C₃alkyl, C₁-C₂alkyl, or C₁₀-C₁₂alkyl. In someembodiments, R^(5a) is hydrogen and R^(5b) is C₂-C₁₂alkenyl, such asC₂-C₅alkenyl, C₂-C₃alkenyl, C₂alkenyl, or C₁₀-C₁₂alkenyl.

In some embodiments, the anordrin or analog thereof has the structure ofFormula (IV),

-   -   wherein R⁶ is C₁-C₆alkyl or C₂-C₆alkenyl;    -   or a pharmaceutically acceptable salt thereof.

In some embodiments, Formula (IV) is Formula (IVa):

In some embodiments, Formula (IV) is Formula (IVa):

In some embodiments, R⁶ is C₁-C₆alkyl (e.g., C₁alkyl, C₂alkyl, C₃alkyl,C₄alkyl, C₅alkyl, or C₆alkyl). In some embodiments, R⁶ is C₁-C₆alkyl,such as C₁-C₃alkyl or C₁-C₂alkyl. In some embodiments, R⁶ is methyl. Insome embodiments, R⁶ is ethyl. In some embodiments, R⁶ is C₂-C₆alkenyl(e.g., C₂alkenyl, C₃alkenyl, C₄alkenyl, C₅alkenyl, or C₆alkenyl).

In some embodiments, the anordrin or analog thereof is anordrin. In someembodiments, the anordrin or analog thereof is a compound having astructure depicted below.

Those skilled in the art will recognize that several embodiments arepossible within the scope and spirit of this invention. The inventionwill now be described in greater detail by reference to the followingnon-limiting examples. The following examples further illustrate theinvention but, of course, should not be construed as in any way limitingits scope.

Examples Example 1

Two estrogen-binding complexes, 4S and 8S, named with respect to therate of ultracentrifugation sedimentation, were reported in uterinecytosol by Mehta et al (18). Anordiol, the unesterified and activemetabolite of anordrin or analog thereof (such as anordrin), was foundto preferentially bind the 8S complex with an affinity of approximately2×10⁵ M⁻¹. In contrast, tamoxifen was found to bind bothestrogen-binding complexes. The selective binding of anordrin or analogthereof (such as anordrin) with only one of the estrogen-binding uterinecytosolic complexes suggests that anordrin or analog thereof (such asanordrin) may modulate specific biological functions regulated byestrogen. There are currently two known pathways modulated by estrogento regulate specific biological functions. We first tested whetheranordrin or analog thereof (such as anordrin) was involved in theclassical pathway of estrogen modulation. The ER-α ligand binding domainwas expressed as a GST fusion protein (GST-ER-α-LBD) in E. coli andpurified using glutathione beads. The binding affinities of anordrin oranalog thereof (such as anordrin), tamoxifen and E2 to the ER-α LBD werecompared using a 3H-E2 competition assay. It was found that 50 nManordrin or analog thereof (such as anordrin) could not inhibit thebinding of 0.5 nM 3H-E2 to 2 μg GST-ER-α-LBD. In contrast, the sameconcentration of either tamoxifen or E2 blocked over 60 percent of 3H-E2binding to GST-ER-α LBD (FIG. 1A). Based on these results, we postulatedthat anordrin or analog thereof (such as anordrin) is not involved inregulating gene expression through the classical pathway of estrogensignaling.

Bcl-2 is a key member of the anti-apoptosis family of proteins. Itsoverexpression has been linked to many kinds of cancers in humans. TheBcl-2 promoter contains an ERE sequence, and Bcl-2 mRNA expression inMCF-7 cells has been found to be positively regulated by E2 andinhibited by tamoxifen (19). In agreement with Nehra's results, we foundthat the expression level of Bcl-2 protein was enhanced by estrogen(FIG. 1C, Lane 1 and 4), and 7.51 μM tamoxifen was found to inhibitBcl-2 expression (FIG. 1C, lane 2). In contrast, the expression level ofeither Bcl-2 mRNA (data not shown) or protein (FIG. 1C, Lane 3) was notaffected in MCF-7 cells treated with 7.5M anordrin or analog thereof(such as anordrin). Neither tamoxifen nor anordrin or analog thereof(such as anordrin) were found to affect Bcl-2 protein expression incells cultured in medium using charcoal-stripped FBS in phenol red freeDMEM medium (FIG. 1C, lane 5 and 6, respectively). The expression ofBRCA1 mRNA has also been reported to be under the control of estrogen inMCF-7 cells (20). We further demonstrated that anordrin or analogthereof (such as anordrin) did not significantly affect the mRNA levelof BRCA1 as measured using RT-qPCR in MCF-7 cells, while tamoxifensignificantly inhibited the synthesis of BRCA1 mRNAs under the sameconditions (FIG. 13B, column 2 and 4). These results further supportthat anordrin or analog thereof (such as anordrin) is not involved inthe classic pathway of estrogen regulation. Interestingly, whileanordrin or analog thereof (such as anordrin) did not appear to modulategene transcription through classic ER pathways, we did find that 7.51Manordrin was able to inhibit MCF-7 cell growth by more than 50% (FIG.13A, column 1, row 1 and 2). Furthermore, treatment of T47D cells with75 μM anordrin or analog thereof (such as anordrin) not only blocked theincrease in cell growth induced by 10 ng/ml EGF, but resulted in afurther decrease below basal levels (FIG. 6).

Insulin (IL) binds to insulin receptor (IR), stimulating thephosphorylation of insulin receptor substrate (IRS) through the insulinlike growth factor receptor 1 (IGFR1) pathway. Phosphorylated IRSinteracts with estrogen-ER complex, which can then translocate into thenucleus to regulate RNA transcription through the estrogen classicalpathway. The proliferation of MCF-7 cells is modulated by IL, and thesensitivity of these cells to tamoxifen was found to be increased afterIL was temporarily removed from culture medium (21) or when IRSexpression was transiently knocked down using IRS-specific siRNA (22).Thus the IL-IRS-IGFR1-ER pathway plays an important role in theregulation of MCF-7 proliferation. Interruption of the IL-IRS-IGFR1-ERpathway should lead to the proliferation of MCF-7 cells being much moredependent on MIES. Consequently, the tamoxifen sensitivity of MCF-7cells with disruption in the IL-IRS-ER pathway would be decreased, whilethe response to modulators of MIES would be increased. To test thishypothesis we induced MCF-7 cells in IL-free medium for two months. Drugsensitivity of cell growth was tested by counting the cell number after144 h of inoculation (FIG. 13A). The data on IC50 of MCF-7 cell growthindicate that UI enhances the sensitivity of MCF-7 cells to tamoxifen(column2), while decreasing the sensitivity to anordrin or analogthereof (such as anordrin) (column 1). Moreover, the presence of 200 nManordrin in the culture medium did not affect the ability of tamoxifento inhibit MCF-7 cell growth (column2—row1 vs row4). As expression ofER-α-36 in MCF-7 cells increased in response to removal of insulin fromthe culture media, the expression levels of GPER1 and ER-α-66 did notchange (FIG. 13C). These results further illustrate that the activity ofanordrin is independent of the classical pathway. Furthermore, theysuggest that anordrin may inhibit MCF-7 cell growth through inhibitionof the MIES pathway, especially such as ER-α-36 pathway.

MIESs effect their regulation of cell proliferation, migration,cell-cell junction and matrix, and energy metabolism through a series ofscaffold protein complexes. ER-α association with the plasma membrane isfacilitated by palmitoylation at residue C447 in the LBD. ER-α-36 is atruncated ER-α variant, retaining the palmitoylation motif (445-453) andpossessing a unique C-terminal 27 amino acid sequence in place of thetypical 140 amino acids (456-595) of full-length ER-α (1). Since ER-α-36possesses a partial LBD and predominantly localizes to plasma membraneand cytosol, it may have impaired estrogen binding, resulting in loss ofthe modulating ability of the estrogen classical pathway. To verifythis, we measured the binding affinity of 3H-E2 with CST-ER-α-36expressed and purified from E. coli. The results indicate thatGST-ER-α-36 expressed from E. coli does not bind to 3H-E2 (FIG. 20). Incontrast, 3H-E2 does bind to GST-ER-α-46, which has a full lengthER-α-LBD. We next confirmed that ER-α-36 expressed in HEK 293 cellsbinds to 3H-E2 with a similar affinity (Kd≈1.9 nM) as found by Kang (23,data not shown). Interestingly, anordrin displayed a biphasic effect on3H-E2 binding to ER-α-36, blocking 3H-E2 binding to ER-α-36 at lowconcentrations and facilitating binding at higher concentrations (FIG.2A). Taken together, our data in light of the published studies onER-α-36 suggest that it may be exclusively involved in the MIES pathway.We proceeded to make use of ER-α-36 to study the physiologicalconsequences of MIES modulation by E2 and SERMs.

ER-α-36 is a unique and highly expressed ER-α variant in MDA-MB-231 andHec1A cells and was demonstrated to regulate cell proliferation throughthe modulation of MAPK/ERK (1/2) pathways (23). We examined thesensitivity of MDA-MB-231 to anordrin in terms of cell growth. Our cellcounting results indicate that 6 μM anordrin inhibits MDA-MB-231 cellgrowth significantly, while tamoxifen treatment has no effect (FIG. 2C).Anordrin treatment was also found to inhibit the proliferation of bothHec1 A and Ishikawa cells at doses ranging from 2-8 μM (FIG. 14A, B).Additionally, anordrin treatment of HepG2 cells showed inhibition ofcell growth characterized by a biphasic dose response, with intermediateconcentrations around 7 μM showing the greatest degree of inhibition(FIG. 7A). Phosphorylation of ERK in HepG2 cells showed a similarnon-monotonic dose response to anordrin treatment, with maximalphosphorylation occurring at a concentration of 10 μM anordrin (FIG.7B), suggesting anordrin may act through the ERK pathway to mediate itsinhibitory effects on cell growth. Based on our findings we predict aroute of action through MIES modulation and propose a useful applicationfor anordrin in a combination therapy protocol to abrogate the sideeffects induced by traditional estrogen blocking treatments.

E2-ER complexes associated with the plasma membrane can modulate thebiological functions of scaffolding proteins, such as Cas-associatedsubstrate (p130Cas), also known as breast cancer antiestrogen resistance1 (BCAR1) in humans. The integrin-p130Cas complex plays a fundamentalrole in the regulation of extracellular matrix (ECM) and cancer cellmigration and invasion. ER-α-36 has previously been shown to modulateMDA-MB-231 cell migration (24). As anordrin has been reported as ananti-angiogenic agent resulting in inhibition of cell migration andinvasion (16), we studied its ability to modulate MDA-MB-231 cellmigration using matrixgel. MDA-MB-231 cells were exposed to either 10 nME2 or 10 ng/ml EGF in combination with anordrin or vehicle control inbasal wells. After 20 hours migrated cells were stained and quantifiedusing a plate reader at 560 nm. We found that both E2 and EGF slightlyenhanced MDA-MB-231 cell migration. 6 μM anordrin significantlyinhibited the migration of MDA-MB-231 cells in medium containing eitherE2 or EGF (FIGS. 2E and F). Interestingly, anordrin more efficientlyinhibited MDA-MB-23 cell migration mediated by EGF than by E2.Furthermore, we knocked down ER-α-36 or GPER1 in MDA-MB-231 cells usingspecific siRNAs. We found that the migration efficiency of MDA-MB-231cells decreased in response to ER-α-36 knockdown. In contrast, the cellmigration efficiency was not affected when expression of GPER1 wasknocked down in MDA-MB231 cells (FIG. 22).

Integrin translocation to the cell surface is regulated by the p130Casscaffold protein complex to play a fundamental role in cell attachmentand migration. Integrin α3β1 has been reported to be involved in MCF-7cell attachment as well as MDA-MB-231 cell migration (25, 26). Ourresults suggest a role for anordrin as a possible down-regulator ofintegrin distribution onto the cell membrane through negative modulationof the E2-ER-p130cas-integrin signaling pathway. To verify thehypothesis, we treated MCF-7 and MDA-MB-231 cells with 6 μM anordrin for16 hours and measured cell surface integrin 13 distribution using aFITC-labeled anti-integrin β1 antibody. We found that anordrindown-regulated integrin β1 distribution to the plasma membrane of MCF-7(FIG. 2H) and MDA-MB-231 (FIG. 2G) cells. However, it did not affect theexpression level of integrin β1 in either MCF-7 or MDA-MB-231 cells(FIG. 15). Taken together, we conclude that anordrin or analog thereof(such as anordrin) binds to membrane-associated ER to inhibit cellmigration and proliferation.

Estrogen also plays an important role in the control of energy balancein female mammals. Estrogen modulation of metabolic signaling affectsthe central nervous system, liver, skeletal muscle, bone, kidney, thecardiovascular systems, etc. The complex of estrogen and its receptorcross-talks with insulin (IL)-insulin receptor (IR) complex orleptin/neuron peptide Y (NPY) and their receptors to regulate foodintake, glucose metabolism and adipocyte composition. While studying theeffects of anordrin and tamoxifen on MCF-7 cell growth, we observed thatthe media of cells treated with anordrin was more yellow, indicatingdecreased pH (FIG. 18). One cause for this would be enhanced glucoseconsumption in anordrin-treated cells compared to those treated withtamoxifen. To determine whether this was the case we treated MCF-7 cellswith different concentrations of either anordrin or tamoxifen for 60hours. The glucose concentration in the culture medium was measuredusing a glucose assay kit. FIG. 3A shows that the glucose concentrationof media from anordrin-treated cells was lower compared to medium fromcells treated with tamoxifen. We next tested whether anordrin couldincrease glucose metabolism in tamoxifen-treated MCF-7 cells. 2×10⁴MCF-7 cells per well in 100 μl medium containing 1 μM tamoxifen and 200nM anordrin were seeded into 96-well plates. Glucose concentration inthe medium was measured after 60 hours. FIG. 3B shows that 200 nManordrin not only reversed the inhibitory effect of 1 μM tamoxifen onglucose metabolism but further enhanced glucose consumption compared tocontrol (FIG. 4B, bar TAM vs bar TAM+ANO). In a mouse model of leptinresistance (db/db), E2 has been shown to increase energy expenditure,leading to reduced body weight (28). We administered anordrin (suspendedin 200 μl sterile water containing 2.5% methyl cellulose) daily at adose of 0.45 μg/g body mass to db/db mice and measured whole bloodglucose weekly for 4 weeks using a glucose assay kit. The results showimproved glucose consumption in anordrin-treated female mice (group 1)compared to controls (group 2) (FIG. 3C). Food intake and body mass didnot change significantly during the testing period (FIG. 16A).Interestingly, anordrin had no affect on glucose consumption in maledb/db mice (data not shown).

Estrogen is one of the key adipokines involved in the regulation ofglucose metabolism, modulating the balance between ATP synthesis anddeposition of fat in adipose tissue. Decreasing estrogen levels can leadto increased fat storage and obesity in postmenopausal women, increasingthe incidence of diabetes II and non-alcohol steatohepatitis (NASH).Consequently, anti-estrogen therapies, such as tamoxifen, enhance theincidence of NASH in breast cancer patients. Our results have alreadyshown that anordrin enhances glucose metabolism in MCF-7 cells and db/dbmice, and we predicted that it could prevent increased liver fat inovariectomized (OVX) mice as well as NASH induced by tamoxifen in normalmice. To test this hypothesis, the ovaries of 6 week old mice weresurgically excised. 3 days post surgery, the mice were givenintragastric injection of ipriflavone, E2, anordrin or vehicle control.Body mass and food intake were measured weekly. We found that after 6weeks body mass increased in ipriflavone and control groups, butremained unchanged in sham, E2 and anordrin groups (FIG. 4A). Foodintake was not affected in any of the groups (FIG. 16B), indicating thedifferences were due to changes in energy expenditure. Mice were thensacrificed to harvest 30-50 mg of liver, and total lipid was extractedusing a 1 ml mixture of chloroform:methanol (2:1) and 0.5 mlphysiological salt solution. Total cholesterol (TC) and triglyceride(TG) levels in the organic phase were measured using TC and TG assaykits (29). The results show decreased amounts of TC and TG in the liversof ovariectomized (OVX) mice for the anordrin and E2 groups compared tocontrols, but no change for the ipriflavone group (FIG. 4D, FIG. 17A).The paraffin sections of livers from the anordrin and E2 groupsexhibited smaller fat deposits compared to those from the control andipriflavone groups (FIG. 4C). To further study the effects of anordrinand tamoxifen on glucose metabolism, normal 6-week old mice were treatedwith either drug alone or in combination. Mice fed with tamoxifen at adose of 4.5 μg/g body mass per day for 9 weeks showed an increase inbody mass (FIG. 4B) and had increased indicators of NASH syndrome (suchas TG deposition in the perinucleus) and liver TG levels compared tocontrol mice (FIGS. 4, E and F). Body weight, NASH syndrome and liver TGphenotypes were completely reversed in mice fed with tamoxifen as abovein combination with anordrin at a dose of 0.45 μg/g body mass (FIGS. 4,B, E and F). Liver TC levels were not different between any of thegroups (FIG. 17B). We also found that anordrin can reverse the increasedserum viscosity and TG levels induced by tamoxifen treatment (FIG. 5).Furthermore, immunofluorescence (IF) staining of paraffin sections ofmice liver using antibodies against GPER1, ER-α, and ER-β respectivelyshowed that only GPER1 was localized at the perinucleus compared toother estrogen receptors (ER-α, and ER-β, FIG. 21). Taken together, theresults suggest that tamoxifen may induce NASH through inhibiting thefunction of GPER1. In contrast, anordrin or analog thereof (such asanordrin) is an agonist of GPER1.

Elevated TG deposition in the perinucleus may be caused by increasedglucose uptake or a decreased cellular ATP concentration. Therefore, wetested whether tamoxifen and anordrin or analog thereof (such asanordrin) can regulate glucose uptake and cellular ATP concentrationsthrough ER-β or GPER1. Glucose uptake was measured using fluorescentlylabeled glucose (2-NBDG), and ATP concentrations were measured using anATP analysis kit. We found that anordrin enhanced 2-NBDG uptake andcellular ATP concentrations (FIGS. 23 A and B) Tamoxifen enhanced 2-NBDGuptake, but decreased cellular ATP concentrations (FIGS. 23 A and B).Combination of anordrin and tamoxifen did not change the 2-NBDG uptakelevel in MCF-7 cells as compared to control with no drug treatment (FIG.23A). This result indicates that anordrin or analog thereof (such asanordrin) and tamoxifen may regulate glucose uptake through inversemechanisms. When ER-α or GPER1 was knocked down individually by specificsiRNAs in MCF-7 cells (FIG. 23C), we found that the effects of each drugon 2-NBDG uptake and cellular ATP concentrations were reduced (FIGS. 23A and B). These results suggest that tamoxifen and anordrin or analogthereof (such as anordrin) regulate glucose uptake and cellular ATPconcentrations through the crosstalk between ER-α and GPER1.

Anordrin or analog thereof (such as anordrin) also has potentialtherapeutic benefits in the treatment of post-menopausal women. It wasfound to prevent uterine atrophy in ovariectomized mice (FIG. 8B) and todecrease the extent of tamoxifen-induced uterine and vaginal atrophy(FIGS. 8, A and C) In particular, a corn oil and casein formulation ofanordrin enhanced its activity to prevent uterine atrophy in mice ascompared to a formulation using methyl-cellulose (FIG. 10). Importantly,while anordrin causes hypertrophy of endometrial epithelial cells inmice, it does not induce endometrial epithelial cell proliferation, withthe epithelium remaining a monolayer, as compared to tamoxifen and E2,which both induce proliferation and development of a polylayer (FIGS. 9,A and C). Combination treatment with anordrin and tamoxifen resulted inneither hypertrophy nor increased proliferation (FIG. 9A).

Osteoporosis is a progressive bone disease common in post-menopausalwomen, characterized by decreased bone mass and density. Decreased serumCa²⁺ concentration ([Ca²⁺]) and increased phosphate concentration([P_(i)]) are clinical diagnostic markers used to indicate progressionof osteoporosis. Anordrin was found to prevent osteoporosis inovariectomized mice as indicated by increased serum Ca²⁺ (FIG. 11A),decreased P_(i) (FIG. 11B) and increased bone density (FIGS. 11, D andE). It was also found to prevent decrease in bone marrow cells (FIG.11C).

Estrogen, tamoxifen and raloxifene all bind to the LBD of ERs tomodulate the estrogen classical pathway. Estrogen replacement therapy ortreatment with tamoxifen or raloxifene can enhance expression of ApoD, acomponent of HDL (FIG. 13B, column3), potentially leading to blood clotformation. We hypothesize that a SERM that does not modulate theclassical pathway of estrogen would not cause blood clots orthromboembolism. After a large scale screen, anordrin was identified asa compound that does not modulate the ER classical pathway, and alsodecreases serum viscosity induced by tamoxifen. We found that the methylgroup in R⁶ of anordrin is essential in decreasing anordrin bindingaffinity to ER-LBD compared with dinordrin (FIG. 1A, dinordrin vsanordrin). Therefore, an alkyl or alkenyl group in R6 of anordrin isnecessary for prevention of blood clots and thromboembolism.

Tamoxifen is a useful therapeutic as an antagonist of the ER classicalpathway, but is also an agonist of mERs, inducing the proliferation ofendometrial epithelial cells. Anordrin can neutralize tamoxifen-inducedproliferation of endometrial epithelial cells, and as such is useful incombination therapy. Based on our findings, we conclude that anordrin isan antagonist of mER. Anordrin does not modulate the ER classicalpathway, but it can enhance estrogen metabolic signaling. We proposethat anordrin is an agonist of GPER1, through which it modulatesestrogen metabolic signaling. In contrast, tamoxifen is an antagonist ofGPER1 and inhibits estrogen metabolic signaling.

Discussion

Estrogen binding to its membrane-associated receptors can lead tocytosolic Ca²⁺ oscillations, conveying signals to the extracellularmatrix (ECM) and impacting cell migration. InsP₃R is one of the majorCa²⁺ channels involved in the regulation of diverse signal transductionpathways. It has been reported to take part in the estrogen modulationof Ca²⁺ release from endoplasmic reticulum (30), and has also been shownto be involved in functional regulation of actin filaments (31).However, the detailed molecular mechanisms underlying this action arenot clearly understood. The E2-ER complex has been reported to regulatecell migration through c-Src (32). c-Src is a non-receptor tyrosinekinase that plays an important role in the regulation of cell adhesion,invasion, growth and differentiation. The key regulatory mechanisms ofc-Src tyrosine kinase involve the control of its phosphorylation statesand kinase activity, which can be modulated by Ca²⁺ signaling induced byE2 interaction with ER. The c-Src-FAK (focal adhesion kinase)-p130Casscaffold reacts with focal adhesion complexes to regulate the actincytoskeleton, resulting in the modulation of cell motility and adhesion.The p130Cas/BCAR1 complex interacts with integrin to regulate ECM andmigration. Anordrin binds to membrane-associated ER and blocks thesignal transduction pathway of estrogen-mediated integrin translocation,resulting in the inhibition of cell migration. Conversely, tamoxifen isan agonist of this signal transduction pathway, and BCAR1, as a corecomponent of this scaffold, is thought to be implicated in thedevelopment of tamoxifen-resistance during the treatment of breastcancer patients. Moreover, the FAK-CDC42-ARHGAP21 pathway has beenreported to regulate the formation of integrin-F-actin scaffold complex,and consequently glioblastomas cell migration (33). We found that thecarboxyl terminus of ARHGAP21 interacts with the carboxyl terminus ofInsP₃R to enhance Ca²⁺ release from endoplasmic reticulum through InsP₃RCa²⁺ channels. The interaction of ARHGAP21 with InsP₃R regulates theformation of F-actin and HEK-293 cell migration. Therefore, we proposethat estrogen binds to membrane associated ER to modulate ECM and cellmigration through a c-Src-CDC42-ARHGAP21-InsP3R-integrin pathway (FIG.12).

EGF binds to Her1, resulting in activation of the c-Src phosphorylationpathway to regulate cell proliferation and migration. Anordrinmodulation of cell proliferation and migration has also beendemonstrated to act through the c-Src pathway. We found that anordrincould block the stimulatory effects of EGF on cell migration inMDA-MB-231 cells and cell growth in T47D cells. When anordrin was usedas an anti-tumor medicine in the 1990's, it was found to improve thequality of life and increase the lifespan of patients whose cancers werepotentially caused by EGF/Her1 and failed to be inhibited by an EGFcompetitor. Our results suggest that anordrin can be used in anti-tumortherapies to treat those patients whose tumor growth is dependent onmembrane-associated ER and the Her1-c-Src pathway.

GPER1 has been primarily considered to be linked to anti-estrogenresistance in reproductive cancers, since it was found to be involved inactivation of MAPK/ERK and PI3K/AKT by estrogen through the EGFR pathwayin ER-negative, but GPER1 positive, breast cancer cell lines (34).Subsequently, it was reported to be abundantly expressed in biopsyspecimens of reproductive cancers from patients. Notably, GPER1expression is associated with tumor size, ER-negative-her-2/neu, andextramammary metastases (35). However, reports showed that knockdown ofGPER1 failed to correlate with ERK activity (36). The GPER1-selectiveagonist G1 also failed to exert an estrogenic effect in the uterus ormammary gland (37). Our results show that anordrin is a pure antagonistof membrane-associated ER and functions as a GPER1 agonist. In contrast,tamoxifen exhibits the opposite properties. Based on our results,combination of anordrin and tamoxifen can therefore minimize the sideeffects of tamoxifen.

Estrogen regulation of energy balance has been reported to be primarilymediated by ER-α. Knockout of ER-α has been shown to result in loss ofestrogen modulation of obesity (39). 25% of GPER1 knockout mice havebeen shown to exhibit obesity (40). In contrast, ER-β knockout mice donot show increased rates of obesity (41). These results suggest thatcross-talk between ER-α and GPER1 is important for the estrogenregulation of energy balance. GPER1 is predominantly localized to theendoplasmic reticulum, where estrogen and phosphatidylinositol 3, 4,5-triphosphate (IP₃) signals are generated, leading to Ca²⁺ release fromInsP₃R (5). White et al. reported that Ca²⁺ release from InsP₃R enhancesthe bioenergetics of mitochondria (42). In the present example, we foundaccumulation of lipid around the nucleus of liver cells in bothovariectomized (OVX) and tamoxifen-treated mice. Taken together, wepredict that GPER1 agonists possibly enhance InsP₃R activity to deliverCa²⁺ from the endoplasmic reticulum to mitochondria, leading to enhancedmitochondrial metabolism of glucose to ATP.

Although GPER1 has been found to also localize to the plasma membrane,cross-talk between GPER1 and IL-IR complex has never been reported. Onthe other hand, estrogen-ER-α not only regulates Glut-4 expression andits translocation to cell membrane (43), it also cross-talks with IL-IRcomplex to regulate glucose uptake in MCF-7 and skeletal muscle cells(44, 45). Interestingly, tamoxifen was found to prevent osteoporosisduring clinical usage. Anordrin was also found to prevent osteoporosisin our experiments (FIG. 11).

Tamoxifen can enhance 2-NBDG uptake and inhibit ATP generation. Theelevated intake of glucose caused by tamoxifen cannot be metabolizedinto APT. Consequently, excess glucose can be transformed into TG. Thischain of events explains why tamoxifen can induce NASH when used forbreast cancer therapy. On the other hand, when excessive amount ofuptaken glucose cannot be metabolized, excessive amount of TG is storedup, leading to inhibition of further uptake of glucose even at thepresence of high insulin concentrations. This scenario may explain whytamoxifen induces insulin resistance, and thereby increases theincidence of diabetes II. Anordrin or analog thereof (such as anordrin)can counteract the effects of tamoxifen on glucose uptake and glucosemetabolism to ATP and TG. Therefore, combination of anordrin andtamoxifen can prevent tamoxifen-induced insulin resistance and incidenceof diabetes U.

Materials and Methods

Plasmid construction, protein expression, purification andcharacterization by LC-MSMS: ER-α ligand binding domain and ER-α-36 werecloned into pGEX-6P-1 at EcoRI and XhoI sites. GST-ER fusion proteinswere induced using 0.1 μM IPTG and expressed in E. coli at 25° C. for 3hours. Bacteria were harvested. GST fusion proteins were purifiedfollowing manufacturer's instructions. Purified protein on GST-beads waseluted using IX sample buffer at 100° C. for 5 minutes. The supernantwas run on 10% SDS-PAGE. Gel was stained using Coomassie blue-R250.Protein bands were cut and characterized by LC-MSMS. ER-α-36 and GPER1cDNAs were purchased from YR gene and subcloned into pRetro-AcGFP andpQXIX-EGFP vectors, respectively (Clontech).

Cell culture, retrovirus packaging, cell sorting and construction ofstable cell line and drug inhibition assay: MCF-7, T47D, MDA-MB-231,Hec-1A, CHO-K1 and HEK-293 cells were grown following ATCC protocol. Theplasmids of pVSV-G protein cDNA with ER-α-36 or GPER1 cDNA wereco-transfected into HEK-293 package cells. After 72 hours oftransfection, supernatant was harvested and concentrated usingultracentrifugation at 25 krpm for 2 hours. Virus was resuspended usingculture medium of stable cells. Cells were infected using virus at 37°C. for 2 hours, grown for 2 days and GFP-positive cells were seeded into96well plates at one cell per well. The expression of GFP fusion proteinwas checked using western blotting.

Binding and competition assays: GST and GST-ER-α fusion proteins wereexpressed in E. coli and purified using glutathione beads. 2 μg/ml GST(40-80 nM) fusion proteins in 1 ml TE buffer was mixed with 1 nM ³H-E2at 4° C. for 2 h. Radioactivity on beads was measured using a GM meter.HEK-293 cells were transfected to express GST fusion proteins of ER-β orGPER1. Cells were lysed in 1×TE buffer containing protease inhibitorcocktail (sigma) on ice for 30 min, 80% glycerol was added to reach 20%glycerol. Tubes were centrifuged at 300 g for 5 min and supernatant wascollected. Protein concentration was measured by Bio-rad proteinconcentration assay kit. 100 nM anordrin and 1 nM ³H-E2 was added to 1ml lysate (5 mg/ml total protein) at 4° C. for 2 h. Radioactivity onbeads was measured using GM meter.

Isolation of microsome and Drug competition assay: Cells were harvestedand lysed in TE buffer (50 mM Tris (pH8.0), 5 mM EDTA, 2 mM PMSF andprotease inhibitor cocktail (Sigma)) for 30 min with vortexing every 5min, 80% glycerol in TE buffer was added to cell lysates to reach 20%and centrifuged at 800 g for 5 min. The supernatant was transferred tonew tubes and total protein concentration was adjusted to 5 mg/ml. Drugsand ³H-E2 were added to 1 ml protein solution and incubated at 4° C. for2 hours. Microsome was precipitated at 25 krpm for 2 hours. Bound ³H-E2was measured using GM meter.

Drug inhibition assay: Cells were inoculated into 24 well plates andtreated using the designated concentration of drugs. Cell number wascounted using a cell counter (Count Star).

Transwell and flow cytometry assay: Cells were starved for 48 hours inphenol red free medium containing 5% charcoal-stripped FBS, and thenchanged into phenol red free medium for an additional 24 hours.Transwell was performed following the Chemicon kit instructions(CAT#ECMS51). Briefly, cells were trypsinized, washed using 1×DPBScontaining Ca2+ and Mg2+ (Sigma) and resuspended in serum and phenol redfree medium at a cell density of 0.5×10⁶ cells/ml. 200 μl cellsuspension containing drugs was added into the upper chamber andinserted into the lower chamber containing 0.5 ml medium with 10% FBSfor 16 hours. Flow cytometry was performed by suspending cells intrypsin-free cell suspension buffer (Millipore), and labeling withFITC-antibody (millinpore) following company instructions.

The specific siRNAs against ER-α and GPER1 were designed according toreferences 46 and 47 respectively, and were synthesized by GenepharmaCo., LTD.

Glucose concentration assay: glucose concentration in medium or totalblood from mouse tail was measured using glucose assay kits followingmanufacturer's instructions (Yicheng, Beijing).

Construction of ovariectomized (OVX) mice model and administration ofdrugs: The ovaries of 6 week old mice were excised by surgery, 3 dayspost surgery drugs were administered by gastric tract injection everyday or mixed with food.

Preparation of paraffin sections and HE staining: The tissue of mice wasexcised by surgery and fixed using 2.5% formaldehyde in 1×PBS. Paraffinsection preparation and HE staining was performed following the standardprotocol from GLP laboratory of BK animal model, Inc.

Measurement of TC and TG in liver and serum of mice: 30-50 mg of mouseliver was excised by surgery and homogenized in 1 ml Cholroform:Methanol(2:1) mixture and extracted using 0.5 ml ddH₂O. The organic phase wastransferred to new tubes and air dried. The amount of TC and TG wasmeasured using kits following manufacturer's instructions. The error wascorrected by using internal standard controls.

Bone density assay using micro-CT: Thighbone was fixed in 1×DPBScontaining 3% formaldehyde for two weeks. The fixation solution wasexchanged after one week. The density of thighbone was measured bySiemens Inveon Micro-CT. Inveon Research Workplace (IRW) was used toanalyze the HU2000 value at the following measurement conditions: 80KVP, 500 mA, 1500 ms exposure time; CCD Readout installation: 2048axial, 2048 binning; FOV Transaxial: 19.03 mm, axial: 19.03 mm, pixelssize: 9.29 μm.

Extraction of cellular lysate, Western blotting, total RNA extractionand RT-qPCR: Cells were harvested and lysed in RIPA buffer or 1×DPBScontaining 1% triton-x100 and protease inhibitor cocktail. Total proteinconcentration was measured using Bio-rad protein staining dye. Westernblotting was performed following standard protocol using nitrocellulosemembrane (Millipore) and Bio-rad semi-dry transfer system. Total RNA wasextracted using RNA extract solution (sigma). RT-qPCR was performedusing the Roche Sybr qPCR kit, ABI7900HT PCR machine using the program:95° C. for 10 min followed by 40 cycles of 95° C. for 10 sec and 60° C.for 1 min.

Statistical analysis: In tables and figures, the results were presentedas mean+STDEV. Asterisks indicate a statistically significant differencecalculated using student's t-test, two-tailed.

Example 2. Binding Assays of Anordrin and Dinordrin

Dinordrin has a similar structure as anordrin except that it has an −Hat R6 position. We found that 50 nM dinordrin blocked 63.2±5.7% of 0.5nM [H³-E2] binding to 1 μg of GST-ER-α-LBD on beads. By contrast, noinhibition by anordrin that blocks [H³-E2] binding to 1 μg ofGST-ER-α-LBD.

Further, 6 μM dinordrin increased Bcl-2 mRNA transcription for147.2%±22.73% (P<0.001). By contrast, statistically non-significantlydifferent by anordrin 3.18%±3.22% in MCF-7 cells was measured usingRT-qPCR.

The results showed that the R6 —CH3 (as opposed to —H) is essential forthe unique functional characteristics of anordrin.

Paraffin was removed from mouse liver sections using xylene. The liversections were stained using antibodies against GPER1, ER-α or ER-βrespectively.

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1. A method of treating a cancer in an individual comprisingadministering to the individual an effective amount of an anordrin or ananalog thereof, wherein the individual is positive for membrane boundestrogen receptor.
 2. The method of claim 1, further comprisingadministering to the individual an effective amount of at least oneother agent selected from the group consisting of tamoxifen, raloxifeneor functional equivalent thereof, and an aromatase inhibitor.
 3. Amethod of reducing side effect of at least one other agent by anordrin,comprising administering to the individual an effective amount ofanordrin or an analog thereof in combination with the other agent,wherein the other agent is selected from the group consisting oftamoxifen, raloxifene or functional equivalent thereof, and an aromataseinhibitor.
 4. The method of claim 2, wherein said other agent istamoxifen.
 5. The method of claim 2, wherein the other agent israloxifene or functional equivalent thereof.
 6. The method of claim 2,wherein the other agent is raloxifene.
 7. The method of claim 2, whereinthe other agent is selected from the group consisting of raloxifene,lasofoxifene, bazedoxifene, arzoxifene, ormeloxifene, ospemifene, andlevormeloxifene.
 8. The method of claim 2, wherein the other agent is anaromatase inhibitor.
 9. The method according to claim 8, wherein thearomatase inhibitor is anastrozole.
 10. The method according to claim 8,wherein the aromatase inhibitor is selected from the group consistingof: anastrozole, letrozole, exemestane, vorozole, formestane, andfadrozole.
 11. The method of claim 1, wherein the cancer is selectedfrom the group consisting of breast cancer, lung cancer, pancreaticcancer, gastric cancer, colon cancer, liver cancer, and CLL.
 12. Themethod of claim 2, wherein the cancer is resistant to treatment with theother agent when not administered in combination with anordrin. 13.(canceled)
 14. The method of claim 1, wherein the individual is positivefor VEGFR or EGFR.
 15. The method of claim 2, wherein the anordrin andthe other agent are administered sequentially.
 16. The method of claim2, wherein the anordrin and the other agent are administeredsimultaneously.
 17. (canceled)
 18. The method of claim 1, wherein theanordrin or an analog thereof is anordrin.
 19. A method of reducing apostmenopausal symptom in an individual, comprising administering to theindividual an effective amount of an anordrin or an analog thereof.20-27. (canceled)
 28. A pharmaceutical composition comprising anordrinor an analog thereof and at least one other agent selected from thegroup consisting of tamoxifen, raloxifene or functional equivalentthereof, and an aromatase inhibitor. 29-37. (canceled)
 38. Thepharmaceutical composition of claim 28, wherein the weight ratio ofanordrin and the other agent in the composition is about 20:1 to about1:20. 39-40. (canceled)
 41. The method of claim 1, wherein theindividual is positive for ER-α-36.